Improving Patient Care Delivery in a Small Alaska Native Health Care Organization PDF
Preview Improving Patient Care Delivery in a Small Alaska Native Health Care Organization
Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2016 Improving Patient Care Delivery in a Small Alaska Native Health Care Organization Annette Cecile Siemens Walden University Follow this and additional works at:https://scholarworks.waldenu.edu/dissertations Part of theHealth and Medical Administration Commons, and theIndigenous Studies Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Annette Siemens has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Monica Gordon, Committee Chairperson, Public Health Faculty Dr. Marie Caputi, Committee Member, Public Health Faculty Dr. Amany Refaat, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2016 Abstract Improving Patient Care Delivery in a Small Alaska Native Health Care Organization by Annette Cecile Siemens MPH-Loma Linda University, 1998 MSN-University of Wyoming, 1986 BSN-BIOLA University, 1979 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University January 2016 Abstract American Indian and Alaska Natives are burdened by a higher incidence of chronic diseases than non-Native populations. In an effort to improve the health status of its patients, the Ukudigaunal Wellness Center (UWC) partnered with the Improving Patient Care (IPC) Collaborative to implement changes designed to improve chronic disease care for Native Alaskans through intensive monitoring of screening for chronic disease and selected chronic disease outcomes. For this program evaluation, the units of analysis were the changes in health service delivery and the resulting patient clinical outcomes. The data source was the Registration and Patient Management System (RPMS), repository for the data collected over the 14 months of the collaborative. This system produced Shewhart run charts to show the percentage screening rates for patients achieving IPC processes and outcome measures. The findings showed that the process measures that met IPC goals were due to improvements in service delivery by UWC. Goals for other services, such as diagnostic screenings, were not met because these clinical components had to be coordinated with facilities outside UWC. Outcome measures for BP and HgbA1c control were not met as these depended on the patients’ abilities to self-manage the required procedures. The implications for social change included: (a) Positive outcome in managing chronic diseases is possible by combining chronic care models with Deming’s model for improvement; (b) Increased patient awareness of chronic conditions and their long term consequences tended to support more responsible and successful patient self-management; (c) Use of external medical resources should be considered when patient privacy and confidentiality are concerns. Improving Patient Care Delivery in a Small Alaska Native Health Care Organization by Annette Cecile Siemens MPH-Loma Linda University, 1998 MSN-University of Wyoming, 1986 BSN-BIOLA University, 1979 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University January 2016 Dedication This dissertation is dedicated to the Unangan people of the Aleutians. Their resilience in the face of many adverse events in history is an inspiration. Acknowledgments I would like to acknowledge my parents who supported me during this extended journey. They encouraged me to keep on pursuing my goals. I would also like to acknowledge James Spillane for his assistance with GPRA and RPMS data retrieval and reports. I would also like to thank my health board committee for their support of this study and for their efforts to improve the health of the Unangan people. In addition, I would like to thank the Indian Health Service IPC National Team for passing on their knowledge and understanding about the IPC process. I would like to also thank Dr. Gordon for her patience with me when circumstances forced a change of topic mid- dissertation and lost motivation to continue. Also, I would like to thank Dr. Caputi for her guidance in the structuring and presentation of my work. Table of Contents List of Tables………………. ....................................…………………………………....vi List of Figures……………….. ......................................................................................... vii Chapter 1: Introduction to the Study ....................................................................................1 Chronic Disease Significance ........................................................................................1 Alaska Native Disparities ..............................................................................................3 Indian Health Service Patient Care Collaborative .........................................................5 Collaborative Goals ................................................................................................ 6 Statement of the Problem ...............................................................................................7 Purpose ...........................................................................................................................8 Nature of the Study ........................................................................................................8 The Research Questions .................................................................................................9 Conceptual Framework for the Study ............................................................................9 The Chronic Care Model ...............................................................................................9 The Model for Improvement ................................................................................. 11 Definitions....................................................................................................................12 Assumptions .................................................................................................................13 Scope…………………………………………………………………………………13 Limitations ...................................................................................................................14 Significance..................................................................................................................14 Summary ......................................................................................................................15 Chapter 2: Literature Review .............................................................................................17 i Introduction ..................................................................................................................17 Types of Studies ...........................................................................................................18 Chronic Disease Management .............................................................................. 18 Collaborative Studies Research ............................................................................ 19 Collaborative Care Management .......................................................................... 19 Research on Health Improvement Collaboratives ................................................ 20 Problems with Collaborative Studies ...........................................................................24 Chronic Care Model .....................................................................................................24 Evaluation as a Research Method ................................................................................26 Studies Using Evaluation as Methodology ..................................................................29 Summary ......................................................................................................................31 Chapter 3: Research Method ..............................................................................................32 Introduction ..................................................................................................................32 Research Approach ......................................................................................................33 Research Setting and Program .....................................................................................33 Description of the Clinic ....................................................................................... 33 Available Clinical Services ................................................................................... 34 Research Methodology ................................................................................................35 Role of the Researcher .................................................................................................38 Study Unit ....................................................................................................................38 Instruments ...................................................................................................................39 Data Collection Process ...............................................................................................39 ii Data Analysis Plan ................................................................................................ 39 Issues and Procedures ..................................................................................................43 Summary ......................................................................................................................43 Chapter 4: Results ..............................................................................................................45 Introduction ..................................................................................................................45 Demographics ..............................................................................................................46 IPC Measures Description ...........................................................................................47 Results of Collaborative Process Measures .................................................................47 Body Mass Index –Screening for Obesity ............................................................ 48 Domestic Violence/Intimate Partner Violence Screening .................................... 50 Depression Screening............................................................................................ 51 Alcohol Misuse Screening .................................................................................... 53 Blood Pressure Screening ..................................................................................... 55 Tobacco Screening ................................................................................................ 56 Cancer Screening .................................................................................................. 58 Colorectal Screening ............................................................................................. 58 Cervical Cancer Screening .................................................................................... 61 Breast Cancer Screening ....................................................................................... 63 Diabetes Comprehensive Care .............................................................................. 65 Tobacco Cessation ................................................................................................ 67 Results of Collaborative Patient Outcome Measures ...................................................68 Control of Blood Pressure ..................................................................................... 68 iii
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