Disparities in Potentially Preventable Hospitalizations Between American Indian and Alaska Native and Non-Hispanic White Medicare Enrollees

Abstract

Differences in disease burden and access to outpatient services may partly explain the higher PPH rates for AI/AN Medicare enrollees. The health care quality measure used in this study (PPH) was developed for the US general population. It is important to consider AI/AN socioeconomic and other characteristics when interpreting findings for such measures and enhancing programs and policies to improve AI/AN health outcomes.

The costs of treating all‐cause dementia among American Indians and Alaska native adults who access services through the Indian Health Service and Tribal health programs

“…Furthermore, limited information exists about treatment costs for older AI/ANs who access services through the Indian Health Service (IHS), 17–20 which includes IHS and Tribal hospitals and clinics and urban Indian health clinics. IHS serves approximately 2.6 million AI/ANs in the United States 21 .…”

Putting Self-Management in the Context of Community-Dwelling American Indians Living With Type 2 Diabetes

“…Strides have been made in engaging adult American Indians (AIs) with diabetes in self-management such as through online options 1 and through the provision of special diabetes programs for Indians. 2 Yet some argue that more can be done to improve overall prevention 3 and optimize opportunities for self-management 4,5 as part of the overall care strategy for diabetes within the Indian Health Service, tribal health services, and AI communities. For example, 1 study suggested that type 2 diabetes mellitus (T2DM) programs consider activities that would strengthen participants’ social support and thus community strength given the role of social support in attenuating psychological challenges, 4 which are associated with diabetes distress.…”

“…A recent study identified that AIs with T2DM were 1.4 times more likely than their non-Hispanic white counterparts to experience potentially preventable hospitalizations (PPHs). 5 PPHs are those admissions that the Centers for Disease Control and Prevention argues might not have been necessary had they been managed successfully in the outpatient setting. 3 AIs are also more likely to forego medical care, particularly in relation to limiting care-seeking behaviors.…”

“…13,14 Reasons for reduced care seeking include variable trust in their patient-provider relationships and the absence of specialty programs at the clinic or community level for diabetes. 5,15 The newly revised DSMES emphasize that the person with diabetes is at the center of his or her care team, undertakes a significant amount of “work in being a patient,” yet engages less than 1% of his or her time with health services. The quality of those services offered relies on the evaluation of behavioral measures such as the patient’s report of self-management activities and psychosocial behaviors, including distress (Standard 10).…”

Self-Determination in Health Research: An Alaska Native Example of Tribal Ownership and Research Regulation

“…AN/AI people across the lifespan consistently rank lowest in the U.S. in a wide range of health outcomes, as well as many social determinates of health [ 13 , 14 , 15 , 16 , 17 ]. A long history of government policies against tribes in the U.S.—including military aggression; deliberate introduction of alcohol and disease; religious schools, federal- and state-run boarding schools; and displacement, internment, and forced relocation—has had lasting negative impacts on the physical, mental, and community health of the AN/AI population for multiple generations and caused intergenerational trauma that contributes to substance misuse and interpersonal violence in AN/AI communities today [ 10 , 18 ].…”