Trends in Quality of Care and Barriers to Improvement in the Indian Health Service

Regional Differences in Dialysis Care and Mortality among American Indians and Alaska Natives

“…13 Thus, examining local or area-based differences in health systems and delivery models (e.g., healthcare access, referral patterns, and performance measures) and patient-level determinants of mortality and disability (e.g., BP and diabetes control, body weight, physical activity, and tobacco use) may provide further insight into pathways responsible for the geographic differences found. 14 Our study findings align with the observations of Narva and Sequist and highlight the long-term impact of structural changes in disease management on the quality of delivered care. 10 Because over 40 percent of AIANs from the general population receive healthcare services outside of the Indian Health Service, area-based provider-training to better identify and manage AIAN patients at risk for progressive chronic kidney disease and disability might further improve care delivery and outcomes particularly to patients who reside in urban areas removed from large tribal communities.…”

“…10 Because over 40 percent of AIANs from the general population receive healthcare services outside of the Indian Health Service, area-based provider-training to better identify and manage AIAN patients at risk for progressive chronic kidney disease and disability might further improve care delivery and outcomes particularly to patients who reside in urban areas removed from large tribal communities. 14,15 Overall, our results suggest that the dialysis care of AIANs is largely concentrated in the hands of relatively few dialysis facilities. This concentration of care was particularly evident among AIANs in the Southwest where 24 facilities provided dialysis care for nearly two-thirds of the regional AIAN dialysis population.…”

Indian Health Service Innovations Have Helped Reduce Health Disparities Affecting American Indian And Alaska Native People

“…Fifteen percent of IHS physicians selfidentify as being American Indian or Alaska Native. 20 This is far higher than the national prevalence of American Indian and Alaska Native physicians (0.5 percent). 21 However, up to 10 percent of IHS physicians report that cultural barriers are commonly present during clinical encounters.…”

“…More than half report that the complexity of care they are asked to manage without specialty input is greater than it should be. 20 American Indian and Alaska Native people experiencing a heart attack have the longest du-ration from symptom onset to arrival at the hospital of any racial or ethnic group. 28 Once they arrive at the hospital, they are less likely than whites to undergo angioplasty or heart bypass surgery because of the lack of cardiac catheterization facilities.…”

Atribución de malos tratos en servicios de salud a discriminación y sus consecuencias en pacientes diabéticos mapuche

“…Específicamente, personas que son discriminadas en salud se caracterizan por una menor búsqueda de atención y mantención del nivel de salud recomendado 9 , escasa voluntad para utilizar los servicios médi-cos 10 y peor adherencia a los tratamientos [11][12][13] . En pacientes diabéticos, la percepción de discriminación se asocia con más síntomas de la diabetes, peor control metabólico y menor práctica de exámenes de HbA1c 5 , menos visitas al médico 14 y mayor abandono del tratamiento [15][16][17] . Personas que son víctimas de discriminación atribuyen este fenómeno a diferentes causas, entre ellas, a su etnia, nivel socioeconómico, género y/o orientación sexual [18][19][20] .…”