Improving Patient Care

1. Improving Patient Care “Leveraging Our United Strength to Advance Tribal Self-Governance” Self Governance Annual Conference New Orleans, LA May 7, 2012

2. Indian Health Service Mission The Indian Health Service (IHS) mission, in partnership with American Indian and Alaska Native people, is to raise their physical, mental, social, and spiritual health to the highest level.

3. Indian Health Care Systems The IHS also supports 34 Urban Indian health clinics across the nation.

4. Mortality Rate Disparities Continue 2004-2006* Ratio: AI/AN to US All Races AI/AN Rate 2004- 2006 US All Races Rate 2005 ALL CAUSES 980.0 798.8 1.2 Alcohol Induced43.0 7.0 6.1 Diabetes 68.1 24.6 2.8 Injuries 93.8 39.1 2.4 Homicide 11.7 6.1 1.9 Suicide 19.8 10.9 1.8 Pneumonia/Influenza 27.1 20.3 1.3 Infant Deaths 8.0 6.91.2 * Per 100,000 population

5. Challenges • The Indian health system faces challenges of: • Population growth – increased demand for services • Rising costs/medical inflation • Difficulties in recruiting and retaining medical providers • Challenges of providing rural healthcare • Increased rates of chronic diseases • Lack of sufficient resources to meet demand for services • Balancing the needs of patients served in IHS, tribal, and urban Indian health programs

6. Population Health From a population health perspective, health has been defined not simply as a state free from disease but as "the capacity of people to adapt to, respond to, or control life's challenges and changes". Frankish, CJ et al. "Health Impact Assessment as a Tool for Population Health Promotion and Public Policy." Vancouver: Institute of Health Promotion Research, University of British Columbia, 1996. Retrieved 2008-10-12. It is an approach to health that aims to improve the health of an entire population

7. IHS Priorities To renew and strengthen our partnership with Tribes To reform the IHS To improve the quality of and access to care, Ensure that our work is transparent, accountable, fair, and inclusive

8. IHS Priorities To renew and strengthen our partnership with Tribes To reform the IHS To improve the quality of and access to care, Ensure that our work is transparent, accountable, fair, and inclusive

9. IPC Program • The aim of the Improving Patient Care program is to change and improve the Indian health system. IPC will develop high performing and innovative health care teams to improve the quality of and access to care.

10. 2007-2009

11. 2009-2010

12. 2011-2012

13. IPC Applications Accepted until May 7, 2012 Applications to participate in IPC 4 accepted May 10, 2012 http://www.ihs.gov/ipc/ IPC 4 “Kick Off” May 22, 2012 www.ihs.ipv

14. “Break Through Series” Model: Major activities of all IPC sites: • Teams will receive extensive training and support in attaining the skills and knowledge in applying methods for improvement. • Six group learning sessions events; • Two face-to-face • Three virtual web-ex based learning sessions • Knowledge gathering session • Action orientated initiative that provides the foundation for continued improvement.

15. Model for Improvement The Plan-Do-Study-Act (PDSA ) cycle is a process for testing a change: (Plan) –develop a plan to test the change, (Do)- carry out the test, (Study) – observe and learn from the consequences, (Act) – determine what modifications should be made to the test. Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.

16. Improving Patient Care Changing care processes that will result in Patients and families at the center of care, An improved experience of care for the patient and family, Better coordination of patient care needs, A satisfying work experience for the health care team Improvements to the health care system that can be replicated across the system. IPC will develop, identify, test, integrate, and spread best practices, improvement strategies and methodologies throughout the Indian health system.

17. IPC Indian Health Medical Home Care Centered on the Patient and Family Care Team Access and Continuity Community Focus Quality and Transparency

18. Improvement Support Teams • Trained in improvement principles • Able to advise on improvement strategies & tools • Available at each Area

19. Learning Network • “Graduates” of IPC Phase 1, 2 and 3 • Continue as a Collaborative Network • Expand IPC • Special projects • Mentors, Leaders

20. Indian Health Medical Home Through the Eyes of the Patient Listening to the Voice of Your Community Access to Care A Team Approach to Care: Proactive Care Team Clinical Information Systems Empanelment & Continuity Self Management Support Leadership for Improvement Governing Body Involvement Quality as a Leadership Strategy 2011 IPC Foundation Series

21. Benefits of IPC • Optimized care team—everyone doing their job • Reduced waste, duplication—efficient • Cost savings—makes other improvements possible • Improved patient processing • Higher quality visits • Self management, patient/family engagement • Customer satisfaction • Improved screening rates, other performance results

22. IPC Levels of Measurement

23. Improvement in Quality of Care:March 2011 – Jan 2012

24. Patient Experience of Care The number of patients in the micro system that responded with a 4 (Agree) or a 5 (Strongly Agree) on the patient experience survey questionnaire: "I received exactly the care I want and need exactly when and how I need it." 70.3 % (December 2011) Source: Improving Patient Care Data Portal

25. Future of IPC • Continue to advance system wide change improvements across the Indian health system; • Develop care coordination • Advanced access • Mobilize tribal and community based health programs • Behavioral health integration within the primary care setting • Blood pressure care coordination with remote monitoring • Integrate and manage new measures that align with national I/T/U initiatives to achieve system level performance that can be assessed monthly; and • Engage financial and administrative staff to link cost reduction with quality improvement.

26. IHS National IPC Team Susan Karol M.D., Chief Medical Officer of Indian Health Service Charlene Avery M.D., Director , Office of Clinical and Preventive Services Lyle Ignace M.D., M.P.H., Director, Improving Patient Care program Candace Jones, CAPT, BS, MPH, Administrative Officer Lisa Palucci CDR, MSN, RN, IPC Collaborative Director Frances Placide CAPT, PA-C, MMS, IPC Collaborative Director Hershel Gorham, IPC Improvement Advisor Susan Anderson, IPC Improvement Advisor Sokenunese (Nese) Myles, IPC Data Manager Elizabeth Dean M.P.H., IPC Evaluation Coordinator Mavis Stephens, IPC Program Management Specialist Nicholas Birdshead, IPC Staff Assistant Contact information: Dr. Lyle Ignace at Lyle.Ignace@ihs.gov