Date of Conferral

2016

Degree

Ph.D.

School

Public Health

Advisor

Monica Gordon

Abstract

Chronic diseases impose heavy burdens on the United States health care system, particularly among some ethnic/racial groups such as American Indian and Alaska Natives who experience higher incidence of these diseases than non-Native population. 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. 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.

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