The Alaska Area Native Health Service (AANHS), Indian Health Service, serves the Native population of Eskimos, Indians, and Aleuts throughout the state of Alaska. Health services are provided by personnel at three health centers, six field hospitals, and one medical center in Anchorage. The Alaska Area Native Health Service is organized through a regional concept and provides health services even in the most remote villages. At the community level, the principal provider of health services is the community health aide, who is funded by the AANHS and hired by the Village Council. The primary objectives of the evaluation effort were to assess the effectiveness of health services and to identify strengths and weaknesses of current health care delivery systems. The evaluators also wanted to demonstrate that medical care could be constructively evaluated to improve medical problem-solving; medical care process and medical outcomes could be evaluated by non-physicians; and a medical care evaluation project could be successfully directed by a Native consumer advocate group. A management-oriented evaluation approach was used. The Alaska Native Health Board Medical Care Committee, the Alaska Area Health Service Provider Review Committee, and the Service Unit Clinical Directors decided which priority health problems would be selected for review . These problems were selected to include elements of prevention, screening, diagnosis, treatment, and follow-up. Criteria that were the benchmarks of effectiveness were translated into audit questions called indicators. Three kinds of indicators were used to measure the effectiveness of health care: 1) population-based indicators--patient oriented--track individuals to determine the distribution, continuity, and end results of health care; 2) health status-based indicators were also population derived and disclosed the percentage of patients for whom a change in health status had been documented; 3) Provider-based indicators focused on employee performance rather than system performance. These indicators disclosed contact percentages between patients and health care systems. Medical charts were randomly selected for audit in the study communities. The study results concluded that the Alaska Native Health Service provided health care of a quality comparable to that of other health Service Units, including the private sector. Other factors influencing health care were also recognized. For example, Alaskan Natives, living in isolated areas, find it extremely difficult to receive appropriate health care due to unusual constraints and conditions, distance, transportation, weather, communication, and cost. Because the study examined medical records, documentation of the indicator items rather than the performance of them, was measured. Because performance of the indicators is considered essential to good care, an improvement in documentation should be considered an intermediate step toward the improvement of health care.
Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-55).
Evaluation of medical care provided to Alaska Natives, Volumes 1, 2, and 3. Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-55). 1977