Payment under Medicare for items and services furnished by Indian Health Service hospitals and skilled nursing facilities: final rule.
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Hospitals, Federal↗
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The Indian Health Service record of achievement.
The Indian Health Service (IHS) was transferred from the Department of Interior to the Public Health Service in the Department of Health, Education, and Welfare in 1955. At that time, the general health of Indian people substantially lagged behind the rest of the U.S. population. This gap was reflected in mortality rates which were several-fold higher for Indians, or reflected in time; there were decades between the dates when the U.S. population achieved certain lower death rates compared with the dates when similar reductions were achieved by Indians. As a result of preventive health programs, improvements in sanitation, and the development of a number of medical advances, substantial progress has been achieved in improving the health of American Indians and Alaska Natives. Life expectancy of Indians has increased 20 years between 1940 and 1980. From 1955 through 1982, the death rate for Indian infants dropped by 82 percent. Also, the age-adjusted death rate for tuberculosis decreased from 57.9 per 100,000 population in 1955 to 3.3 in 1983. These and other improvements are summarized in this paper.
Adolescent↗
The Indian Health Service approach to alcoholism among American Indians and Alaska Natives.
The transfer to the Indian Health Service (IHS) of 158 alcohol treatment programs that had been administered by the National Institute on Alcohol Abuse and Alcoholism began in 1978. Today, approximately 300 alcohol and substance abuse treatment programs offer services to American Indians, among them primary residential treatment, halfway houses, outreach, and aftercare. This system provides a national network upon which additional activities may be established. Along with increasing its attention to health promotion and disease prevention, the IHS has moved toward the prevention of alcoholism. A variety of preventive programs are in place that emphasize improved self-image, value and attitude clarification, decision-making, and physical and emotional effects of alcohol and substance abuse. Many begin as Head Start programs and continue through adulthood. In 1986, after consulting with both academic and tribal experts, the IHS devised a strategic plan for alcoholism control that stresses comprehensive care and prevention activities; it serves as a guide for further program development. The Secretary of Health and Human Services created a Task Force on Indian Alcoholism in 1986 to serve as a coordinating body for activities carried out by the IHS and other agencies and units of the Department. Passage of the Anti-Drug Abuse Act in 1986 added resources for the development of adolescent treatment centers and, more importantly, for community-based pre- and post-residential care for youths and their families. Concomitant with these initiatives have been several instances of increased attention by various tribes to the problem of alcoholism. The IHS strategic plan, together with the Secretary's initiative, the Anti-Drug Act, and tribal actions, has added substantial momentum to efforts directed at controlling alcoholism among American Indians. Although the mortality rate from alcoholism is about four times greater for the American Indian population than for the entire U.S. population, it decreased from 54.5 per 100,000 population to 26.1 between 1978 and 1985-a reduction of 52 percent.The philosophy of the IHS in emphasizing prevention of disease and promotion of wellness provides an opportunity for continuing the considerable progress already made. The critical and decisive role played by the Indian communities themselves will determine whether ultimate success can be achieved.
Adolescent↗
Pharmacy practice in the Indian Health Service.
The current status of pharmaceutical services in the Indian Health Service (IHS) is described. IHS is a nationwide program for providing health-care services to more than 960,000 American Indians and Alaska Natives who live on or near federal Indian reservations. Because IHS pharmacy practice revolves around the needs of the patient, pharmacists have close and frequent contact with patients and must have an acute sensitivity to and respect for the cultural values and beliefs of the patients. Ambulatory-care services are emphasized; pharmacists often provide primary care to patients and make frequent use of prescribing authority. All prescriptions are filled directly from the patient's permanent health record, and private patient consultation rooms are used extensively. In the inpatient setting, pharmacists obtain medication and related histories from newly admitted patients and provide patient counseling at the time of discharge. Pharmacists are also actively involved in facility-wide programs and committees (especially those that deal with quality assurance and facility accreditation) and serve as preceptors of pharmacy residents and students. In the future, IHS pharmacy practice will emphasize the expansion of patient-care activities and primary-care programs, effective use of prescribing authority, and the refinement of patient consultation services, services for the elderly, home health-care services, and inpatient clinical services.
Ambulatory Care↗
Advanced nursing practice with the Indian Health Service.
Work with the US Indian Health Service is an exciting and rewarding experience. It allows family nurse practitioners the opportunity to use a wide range of skills and to develop true family and community involvement.
Health Services Needs and Demand↗
Effects of clinical nutrition education and educator discipline on glycemic control outcomes in the Indian health service.
OBJECTIVE: We used the Indian Health Service (IHS) Diabetes Care and Outcomes Audit to assess the effectiveness of clinical nutrition education in reducing HbA(1c) levels and to test the relative effectiveness of clinical nutrition education when it was delivered by a registered dietitian (RD) compared with an educator from another discipline (non-RD). RESEARCH DESIGN AND METHODS: We examined clinical care data collected by the IHS Diabetes Care and Outcomes Audit of 7490 medical records during 2001. Glycemic control was assessed by using the difference between the two most recent HbA(1c) levels during 2001. Age, BMI, duration of diabetes, type of treatment, proteinuria, and facility were included as covariates. Clinical nutrition education was defined as documentation in the record of any diet instruction and educator discipline classified as RD or non-RD. ANCOVA methods were used to assess the effects of diet education and educator discipline on differences between the two HbA(1c) measurements and to adjust for differences in the distribution of covariates among the education groups. RESULTS: After adjustment for age, sex, type of treatment, duration of diabetes, BMI, initial HbA(1c) level, and clinical facility, clinical nutrition education and educator discipline were each associated with changes in HbA(1c) levels (P < 0.001). Those receiving clinical nutrition education from an RD or from an RD as well as a non-RD had the largest improvements in HbA(1c) levels (-0.26 and -0.32, respectively) compared with those receiving either only non-RD or no clinical nutrition education (-0.19 and -0.10, respectively). CONCLUSIONS: Clinical nutrition education in the IHS is associated with favorable trends in glycemic control. To be effective, clinical nutrition education should be delivered by an RD or a team that includes an RD.
Adult↗
Geographic composition of the Health Service Delivery Areas (HSDA) established by regulations of the Indian Health Service--PHS. Notice.
On September 16, 1987, a final rule establishing new eligibility criteria for Indian Health Service [IHS] programs was published in the Federal Register. In the fiscal year 1988 Appropriations Act [section 315, Pub. L. 100-202], the Congress delayed implementation of the regulations from March 16, 1988, to September 16, 1988. Congressional delay to further study the impact of the regulation is possible. This list will help define the parameters of such a study. This designation of HSDA is not effective until September 16, 1988, or such later date as may be established by the Congress.
Catchment Area, Health↗
Role development of the clinical nurse specialist within the Indian Health Service.
The clinical nurse specialist is employed in many health care facilities to improve patient care. One service unit of the Indian Health Service has expressed interest in the development of this role. At the present time, there are no advanced practitioners within this facility. Development, as well as implementation of the role, must be based on the cultural and health care needs of the Indian people. This paper discusses development of the role of perioperative clinical nurse specialist, based on personal experience, at a service unit providing health care to a large tribe of American Indians in the Southwestern United States. Examples of care incorporating cultural practices, are used to illustrate the practice of the perioperative specialist within the Indian Health Service. The nursing process is used to organize the development of the role.
Cross-Cultural Comparison↗
Indian Health Service; statement of organization, functions, and delegations of authority--PHS.
Part H, chapter HG (Indian Health Service) of the Statement of Organization, Functions, and Delegations of Authority of the Department of Health and Human Services, Public Health Service (PHS), chapter HG, Indian Health Service (IHS), 52 FR 47053-67, December 11, 1987, as most recently amended at 56 FR 22015-16, May 13, 1991, is amended to reflect the establishment of an organizational substructure for the Bemidji Area Office to more accurately reflect current activities in the Area Office.
Community Health Services↗
Gold Award. A national program supporting mental health services for Native Americans. Mental Health Programs Branch, Indian Health Service, U.S. Public Health Service.
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Awards and Prizes↗
End-of-life issues for American Indians/Alaska Natives: insights from one Indian Health Service area.
BACKGROUND: In the United States, the American Indian and Alaska Native (AI/AN) population is aging and the leading causes of death for those 55 and older are chronic diseases such as cancer, heart disease, and the complications of diabetes. Since 1955, the federally directed Indian Health Service, along with Tribal governments has been providing comprehensive health care to over 500 AI/AN communities. OBJECTIVE: This is the first study to examine end-of-life and palliative care issues broadly at selected Indian Health Service facilities in the Albuquerque area. DESIGN: Retrospective medical records review identified from randomized New Mexico Department of Health American Indian resident death certificates, 50 years of age and over, from 1994-1998. Interviews with hospital administrators, medical records personnel, and cultural advisors regarding end-of-life policies and procedures were conducted. RESULTS: The study documents very limited formal palliative care services available to rural and reservation-dwelling American Indians and Alaska Natives. However, new initiatives and training in palliative care are emerging. CONCLUSIONS: Recommendations for fostering expansion of end-of-life and palliative care services for AI/AN persons are discussed.
Aged↗
Pine Ridge Indian Health Service Primary Care Resident Rotation: a summary.
The Pine Ridge Indian Health Service Primary Care Resident Rotation was officially established in January 1992 and operated through May 1996. Sponsored by an Indian Health Service grant, the rotation was conceived in an effort to help address the problem of recruitment and retention of physicians at Pin Ridge in the long term, while offering a unique educational experience for residents. Fifty-eight residents from 40 Family Practice, General Internal Medicine and General Pediatric Residency Programs in 18 states completed the rotation. Four of the rotation "graduates" are currently employed by the IHS at Pine Ridge and two other sites. A fifth physician provided short term service to a fourth site.
Curriculum↗
Multiple variable motivators involved in the recruitment of physicians for the Indian Health Service.
Attracting physicians to serve in isolated areas, often with marginal facilities, support staff, and remuneration, has long been a problem of the Indian Health Service (IHS). Until recently the physician draft was instrumental in motivating physicians to accept such assignments. Realizing that this "negative incentive" would no longer operate when the draft ended as of July 1, 1973, in the fall of 1972 the IHS staff launched some major "positive" efforts to recruit physicians. The mass media and other communication techniques were used to try to sell U.S. physicians and medical students on what the Service could offer them in terms of adventure, challenge, personal fulfillment, idealism, and the opportunity to be part of a progressive, comprehensive health system. Such efforts assisted in recruiting 69 physicians to begin service in July 1973. These 69 were in addition to approximately 100 who had already been recruited from among persons who had expressed interest in joining the Indian Health Service or who had applied to it before inception of this major recruitment effort. As of July 1, 1973, however, the Service was still approximately 30 physicians short of filling 200 vacancies. In June and July of 1973, an evaluation was done to determine what had motivated the 169 physicians to join the Indian Health Service. They were asked an open ended question: What prompted you to seek employment with the Indian Health Service? Whether physicians listed personal, subjective motivators or recruitment techniques was of as much interest as the specific answers they gave. More than 75 percent (100 of 129) mentioned recruitment techniques, such as magazine advertisements, rather than personal motivating factors, such as challenge. Personal contact with a present or former IHS physician seemed to be especially influential in attracting physicians. The present state of the recruitment art does not provide the means to adequately identify, qualify, quantify, and rank the multiple motivators that prompt physicians to join a program such as that of the Indian Health Service; nor does it allow for meaningful, predetermined identification of a limited pool of physicians who would have a high probability of joining such a program. At present, the best recruitment strategy appears to be to saturate the entire physician "marketplace" stressing with a variety of techniques the positive aspects of IHS employment. Physicians then select themselves for such employment by exhibiting a more than casual interest in the Indian Health Service.
Advertising↗
Student and resident education and rural practice in the Southwest Indian Health Service: a physician survey.
BACKGROUND AND OBJECTIVES: The Indian Health Service (IHS) is an educational rotation site for numerous medical students and residents. These IHS rotations may be an important factor in recruitment and retention of physicians to the IHS. We describe the combined number of student/resident rotations in the Southwest IHS and their influence on recruitment and retention. We also analyze factors related to choice of rural practice in the IHS. METHODS: We conducted a survey of clinical directors and IHS physicians in Arizona and New Mexico. RESULTS: Twenty (87%) clinical director surveys and 289 (66%) physician surveys were returned. More than 400 students/residents participate in rotations annually in the IHS in Arizona and New Mexico. Eighty-four percent of clinical directors feel that educational programs are important to recruitment. Forty-five percent of current IHS physicians participated in IHS rotations as students or residents, and 87% feel that rotating influenced their decision to join the IHS. Eighty percent of IHS physicians who teach feel that working with students and residents improves their job satisfaction. Seventy-five percent of respondents practice in rural areas. Rural medical student and resident rotations are associated with subsequent rural practice. CONCLUSIONS: Many medical students and residents rotate in the Southwest IHS. Clinical directors state that these rotations are helpful to recruitment, and IHS physicians who rotated feel it was important in their decision to join the IHS. IHS clinicians feel that teaching improves job satisfaction.
Arizona↗
Clinical annotation of tobacco use in patient charts at Indian Health Service clinics and hospitals.
Few clinicians would doubt the importance of obtaining smoking histories from their patients. Nevertheless a clinicians' practices of documenting tobacco use in medical records varies substantially among individual providers and between different health care systems. To investigate the chart documentation of patient smoking among Indian Health Service clinicians, we reviewed 545 randomly selected patient records from 22 different Indian Health Service affiliated clinics. We focused on differences in charting of tobacco use by type of clinic and by geographic area within the Indian Health Service. Documentation varied by area, ranging from no documentation in the Albuquerque, Navajo, and Phoenix areas to 51% in the Oklahoma area. We conclude that clinicians practices of documentation of tobacco use vary widely and recommend that this practice be more widely encouraged at all affiliated Indian Health Service clinics.
Adolescent↗
Cessation of services to terminated Utes--Indian Health Service. Notice.
The IHS is correcting a regional policy of providing services to descendants of terminated Utes. The regional practice of deeming descendants of terminated Utes eligible for IHS services has been determined to be contrary to the purpose of the Ute Termination Act 25 U.S.C. 677, as we interpret that Act, and therefore, descendants of such terminated Utes are outside the scope of authorized IHS services.
Eligibility Determination↗
Big changes in the Indian Health Service: are nurses aware?
Unparalleled challenges currently face the Native American health care system. These challenges are a result of several factors, including (a) external pressures to reduce the overall cost of health care in the United States, (b) increased assumption of responsibility for delivery of health care by tribal governments, (c) decreased direct supervision by the Indian Health Service (IHS), (d) insufficient funding for Indian health care, and (e) increased interest of managed care to contract with tribal service units for health care. This article explores the opportunities and challenges facing Native American health care delivery and examines nursing policy issues pertinent to the current state of the IHS.
Attitude of Health Personnel↗
Suicide prevention efforts in one area of Indian Health Service, USA.
Suicide is the second leading cause of death in young Indian people. USA's Indian Health Service is responsible for the health of the people; a structured system and services are provided. These services include surveillance and suicide investigation, to allow for better understanding. This article presents the current epidemiology on suicide for American Indians and Alaskan Natives (AI/AN). The data show a very high rate in the young, especially males. Beyond the general, the article offers a unique look into a suicidal AI/AN young person, through the psychological autopsy. A case illustration, E.S., a 16-year-old male who died by suicide, is outlined. Discussion, the author's words, and current efforts of Indian Health Services are presented, but it is concluded that much greater effort is needed.
Adolescent↗