Community Oriented Primary Care A Practical Assessment, Vol. 2: Case Studies (1984) / Chapter Skim
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Sells Service Unit of the Indian Health Service
Sells Service Unit of the Indian Health Service
Pages 137-162
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From page 137... ...
The Indian Health Service has not been the subject of the intense evaluation efforts that characterize the history of many other federal health programs. Consequently the re is a very small body of published literature that describes either the operations, the costs, or the impact of this particular model of COPC.
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From page 138... ...
The emergence and implementation of the community health representative program {CHR} is largely attributed to his leadership. · A tr ibal health board (the Executive Health Staf f ~ was created in 1972 by the Tr ibal Council and all health matters were delegated to this group.
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From page 139... ...
In addition to the services provided directly by the Indian Health Service, a wide array of services are available through tribal health programs supported by IBS contract funds. In the summer of 1983, the tribal health programs included a nutrition program, a disease control program, psychological servicer, an alcoholism program, a program for the elderly, the community health representative program, ~ program for traffic and highway safety, and the Papago Children's Home.
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From page 140... ...
PCIS produces a health summary by which the practitioner, at each patient visit, is given a concise overview of a patient's relevant health care data . Me health summary egg regales data f rom the patients multiple encounters with different practitioners and facilities, and contains a variety of information including demographic data, measurements, problem lists, active medications, previous inpatient and outpatient encounters, immunizations, skin tests, and lab/X-ray results.
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From page 141... ...
with the Department of Family and Community Medicine of the University of Arizona. Family practice residents rotate through the San Xavier Health Center and medical and other health professional students participate in the research
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From page 142... ...
which has an Indian Health Service-wide research and development responsibility. ORD is phys ically located in the same building as the San Xavier satellite health center.
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From page 143... ...
TABLE 8.2 IES/Sells Service Unit Revenues for Clinical Services Category and by Year .
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From page 144... ...
Not all of the IES recurring budget funds go to the service unit for direct service delivery. They are distributed among the service unit for actus1 provision of services, the several tribal health prom grams administered and implemented by tribal health workers, and nonIRS and nontr ibal providers in the form of contract health services.
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From page 145... ...
The urban Indian population also may receive health services f rom the Traditional Indian Alliance, a health care program operating in Tucson and supported in part by funds f rom the Indian Health Service. According to the 1980 census, there were 8, 900 Papagos on the reservation, while the PCIS data base includes 14, O 50 Papago registrants fran all of southern Arizona.
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From page 146... ...
Community Involvement Community participation in the health program comes largely through the Execut ive Health Staf f, which cons ists of the heads of the var ious tribal health programs funded by the Indian Health Service. The Indian Bealth Service encouraged the development of this group as a way to institute broader organization and planning on the tribal side with regard to Indian Bealth Service-funded program.
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From page 147... ...
The program has continued since 1968 and has been funded by the Indian Health Service. Two studier of the tribal health programs recently have been published (Atencio, 1974 ; Bashur, 1979)
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From page 148... ...
The prenatal care services were reorganized and concentrated on particular days at the Sells Hospital outpatient department. Specif ic protocols were d eve loped to guide the care of prenatal patients, with distinctions on the content and timing of specif ic care Casks determined as a function of the patients risk status.
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From page 149... ...
Under the leadership of the tribally operated Disease Control Program {one of the IES-funded tribal health programs) an effort was modeled af ter the successful and highly publicized school-based program to control streptococcal disease in Casper, Wyoming.
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From page 150... ...
Congress and the Director of the Indian Health Service. In 1979, the Papago Tr ibal Specif ic Bealth Plan in the section on demographic and health data reported that diabetes mellitus affects more Papago.
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From page 151... ...
According to the service unit plan, the effectiveness of this program will be measured in terms of: number of hospital admissions for diabetes number of admissions for complications of diabetes total hospital days for diabetic patients number of diabetic visits to podiatrist and dietician number of diabetic patients seen by ophthalmologist number of cc=~unity health worker visits to homes of diabetic patients number of diabetic patients using Sells services. Immunization in Children In the mid-19 70s, there was a growing awareness that the health care system in most of the United States was generally relaxing its efforts at routine childhood immunization.
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From page 152... ...
In many cases, problem identif ication at Sells is a long-term consensus building effort, involving the tribe and its various levels of decision making as well as the Indian Health Service. Thus, many examples would be inaccurately descr ibed as a stepwine process in which certain data were gathered, analyzed, and a program decided upon.
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From page 153... ...
However, these reports have not been available for several years. During a recent data conversion as part of an effort to standardize the data Sets of the various patient care data systems within the Indian Health Service, the Health Status Report had to be rewritten and it in currently in the backlog of programs waiting to be modified.
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From page 154... ...
Stage TV differs fray III in the use of evaluation techniques that are specific to program objectives and account for differential impact among risk groups. Both the efforts to address infant gastroenteriti~ and to improve prenatal care identif fed specif ic high risk individuals and groups, and monitored the program impact on each.
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From page 155... ...
A1 though it would be possible for the CHR program to function in a very limited way, such as merely delivering patients to the service unit without being integrated into a co~nunity~oriented care system, it appears that at Sells the CARS operate as functional members of informal community Stealth teams. Finally, of particular importance is the location of the Indian Health Service Office of Research and Development within the Tucson Program Area.
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From page 156... ...
Sells we. among the first of the OHS service units to permit the use of that budget category for supporting a wide range of tribal health programs.
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From page 157... ...
Like other large federal programs, the THS must also comply with a complex set of regulations and often administrative obstacles make planned program modif ications cliff icult. The Community The Sells program, like other Indian Health Service units, serves an actively functioning sac iocultural community.
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From page 158... ...
TABLE 8.4 Cooper ison of the Level of Development of the Ma jor Functional Elements of COPC in the Sells Service Unit Identify Modify Def ine and Community the Monitor Character ize Health Health Impact of the Community Problems Program Modif ications STAGE O STAGE I STAGE I I DIABETES IMMUNIZE STAGE I II X GAS TRO DIABETES IMMUNIZE IMMUNIZE STREP STREP STREP DIABETES PRENATAL STAGE IV GAS TRO GAS TRO PRENATAL PRENATAL GAS5~0 refers to the emphasi~s program to address infant gastroenteriti~. IMMUNIZE refers to the program to increase the rate of immunization in children.
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From page 159... ...
D ., c 1 in ic fan Francisco Jose, Vice Chairman, Papago Tribe of Ar Ozone Rosemar ie Lopez, Tribal Council Fred Stevens, Tribal Council Cecil Williams, Sells Service Unit, Project Officer Pauline Sequiero, Social Services, Sells Service Unit Sister Solano Schmedler, Director of Medical Records, Sells Service Unit Geraldine Guyon, R.N., Director of Community Health Nursing, Sells Service Unit Elisa Hurtado, H.D., Office of the Director, Tucson Program Area
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From page 160... ...
A Journey in Self Reliance: A Report on the Status of Papago Health Programs, Sells, Arizona. Bashur, Re 1979e Technology Serves the People: The Story of a Cooperative Telemedicine Project by NASA, the Indian Health Service, and the Papago People.
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From page 161... ...
1975. Process and outcome measures of tribal health workers in direct patient care.
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