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AJPH First Look, published online ahead of print Jul 28, 2005
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Charlton Wilson
Theresa Cullen
Kelly Moore
Lorraine Valdez
William Vanderwagen
Kelly Acton
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©
American Journal of Public Health, 10.2105/AJPH.2004.053710

Health Policy and Ethics

Diabetes Outcomes in the Indian Health System During the Era of the Special Diabetes Program for Indians and the Government Performance and Results Act

Charlton Wilson 1*, Susan Gilliland 2, Theresa Cullen 3, Kelly Moore 4, Yvette Robideaux 5, Lorraine Valdez 4, William Vanderwagen 6, Kelly Acton 4

1 Indian Health Service, Phoenix Indian Medical Center
2 University of Southern California, Department of Preventive Medicine
3 Indian Health Service, Office of Information Technology
4 Indian Health Service, Division of Diabetes Treatment and Prevention
5 Mel and Enid Zuckerman Arizona College of Public Health, The University of Arizona
6 Indian Health Service, Office of Clinical and Preventive Services

* To whom correspondence should be addressed. E-mail: charlton.wilson{at}ihs.gov.


  Abstract

Objectives. We reviewed changes in blood glucose, blood pressure, and cholesterol levels among American Indians and Alaska Natives between 1995 and 2001 to estimate the quality of diabetes care in the Indian Health Service (HIS) health care delivery system. Methods. We conducted a cross-sectional analysis of data from the Indian Health Service Diabetes Care and Outcomes Audit. Results. Adjusted mean Hemoglobin A1c (HbA1c) levels (7.9% vs 8.9%) and mean diastolic blood pressure levels (76 vs 79 mm Hg) were lower in 2001 than in 1995, respectively. A similar pattern was observed for mean total cholesterol (193 vs 208 mg/dL) and triglyceride (235 vs 257 mg/dL) levels in 2001 and 1995, respectively. Conclusions. We identified changes in intermediate clinical outcomes over the period from 1995 to 2001 that may reflect the global impact of increased resource allocation and improvements in processes on the quality of diabetes care, and we describe the results that may be achieved when community, health program, and congressional initiatives focus on common goals. (Am J Public Health.2005;95:XXX-XXX. doi:10.2105/AJPH.2004.053710)

Key Words: Diabetes, Government, Health Policy, Quality of Care, Native Americans




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