This report describes a method designed to assess the quality of ambulatory health care in the Indian Health Service (IHS). This report is the second phase of a three-part project on ambulatory care quality assessment conducted the Office of Research and Development, IHS. The first part of the evaluation was a description of the design phase. The second report summarizes the conceptual basis of the methodology and describes a pilot study conducted in six IHS units. The third volume compares three different types of health care units. This report focuses on the success of the methodology applied in the IHS units.To begin the pilot test, seven tracer conditions were selected on the basis of severity of impact on the patient. The tracer conditions included: severe lacerations, iron deficiency anemia, urinary tract infection, prenatal care, infant care, streptococcal infection, and hypertension. Specific patient cohorts were identified by tracer condition and monitored by criteria indicators. These indicators describe the continuity, distribution, and appropriateness of provider care. The indicators are aggregated into three major types: population based, provider based, and health status indicators. The results were tabulated in frequency tables. Statistical tests of significance were not applied systematically. However, spot checking revealed that certain trends tended to be consistent across the six pilot study sites.The study showed that there were relatively low rates for counseling and educational activities in maternal and children's health care processes. In several cases, the limiting factor in the provision of health service was noted to be a lack of recognition of need by the provider. The criteria for diagnostic, treatment, and follow-up indicators are not sufficiently comprehensive or predictive. Finally, the study showed that substantial improvement could be made with respect to continuity of care.Some of the 16 detailed findings of the study are listed as follows: 1) the functional cost per medical encounter is highest in the family health center programs, and lowest in the maternal and infant care programs; 2) physician productivity varies widely among programs; 3) there is a complete lack of uniformity in the manner in which each provider category reports case workloads and cost data; 4) costs vary widely by region and urban location; and 5) the annual average cost of health care services nationwide was $282.50 per person in 1974.
Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-12).
Nutting PA. Helmick EF. Falvey RE. Selby G. Studies in ambulatory care quality assessment in the Indian Health Service, Volume II, Appraisal of System Performance. Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-12). 1977