Project Background: American Indians and Alaska Natives (AI/ANs) have the highest prevalence of diabetes among all US racial and ethnic groups. In fiscal year (FY) 2010, the diabetes prevalence among AI/AN adults who obtained services through Indian Health Service (IHS) was 14.6%, nearly double the US rate. Compared to other racial groups, AI/ANs are more likely to develop type 2 diabetes at younger ages and to have more diabetes-related complications. These factors substantially increase diabetes-related mortality. Although diabetes is the seventh leading cause of death in the United States, it ranks fourth among AI/ANs. Heart disease is the leading cause of AI/AN mortality and a common complication among those with diabetes. AI/ANs have the highest rate of premature deaths from heart disease among all races; that is, they are more likely to die from heart disease before age 65 that other races. To address this need, IHS and tribes collaborated with the Centers for American Indian and Alaska Native Health (CAIANH) to create a project data set from existing data sources that are stored in different computer systems, to increase their capability to evaluate health services. We propose to use these data and the collaborations we developed as part of the previous project for this study.
Project Goal: The project goal is to provide information that may be used to improve health outcomes among AI/AN adults with diabetes and cardiovascular disease (CVD). Project Methods: The study population includes approximately 14,600 AI/AN adults with diabetes and CVD who use IHS services and lived in 15 project sites during FY2012. The data infrastructure includes data for FY2011–2012. Building on existing collaborations, we will create a collaborative network that includes CAIANH, IHS and tribal health program representatives, and patients to provide advice and guidance on all aspects of the study. Patients will provide input on all study activities. First, we will conduct analyses to better understand the patients’ needs. These will include analyses of health status, service use, and treatment costs. Second, we will conduct a study to evaluate how use of education, case management, and advanced practice pharmacy services influences patient outcomes. The collaborative network will identify which patient outcomes should be studied. They may include health status outcomes based on clinical measures (e.g., blood pressure, glycemic and cholesterol levels) and health care quality outcomes such as preventable use of inpatient services and hospital readmissions. Finally, the collaborative network will use these findings to identify strategies that may facilitate patients’ ability to make informed choices about using education, case management, and advanced practice pharmacy services, and enhance the provision of these services to better address patients’ needs.
In the Navajo Nation, a Focus on Health Data
Native Americans have disproportionately high rates of diabetes. Two PCORI studies, including this study, are searching for answers in the Navajo Nation and its health data. Challenges abound—including far-flung geography, low health resources, and language barriers—but together Navajo researchers and community health workers are meeting them. This blog was co-authored by Joan O'Connell, PhD, this study's principal investigator.
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