Presentation Abstract

Title: The Role of Health Care Systems in Preventing Chronic Disease in American Indian and Alaska Native Communities

Background: Beginning in 1995, tribally owned Southcentral Foundation (SCF) incrementally assumed responsibility from the Indian Health Service for primary care services on the Alaska Native Medical Center (ANMC) campus in Anchorage, Alaska. SCF has implemented components of a Patient-Centered Medical Home (PCMH) model and made other systematic changes to improve access and continuity of care, enhance quality of care, increase patient satisfaction, reduce costs, and increase revenue. In 2005, SCF developed a research policy to provide direction for all research activities occurring on the ANMC campus and opened a research department in 2006 to conduct research on tribally-identified priorities.  Objectives: 1) Describe key elements of SCF’s system of care along with performance metrics and/or research findings; 2) Provide considerations for healthcare systems and researchers when working with tribal communities. Results: Implementation of PCMH at SCF was accompanied by decreases in hospitalizations and emergency room visits as well as increased likelihood of blood pressure and glycemic control.  SCF has consistently performed at the 75th to 90th percentile across many HEDIS measures tracking quality of care. Satisfaction with care has increased from 50% to over 95%. The SCF Research Department has grown from 9 to 25 staff with a burgeoning portfolio of health services and ethical, legal, and social implications (ELSI) research. With appropriate tribal oversight and use of Community Based Participatory Research methods, Alaska Native and American Indian people have volunteered for SCF research studies involving genetics and other potentially stigmatizing conditions such as alcohol misuse. Conclusions: The PCMH model and other healthcare improvements show promise in ameliorating chronic disease and other health disparities among Alaska Native and American Indian people. The SCF example also provides a framework to reshape the future of health and related research in Alaska Native and American Indian communities.

About Dr. Dillard

Denise A. Dillard is an Inupiaq Eskimo, born and raised in Alaska. She left Alaska for about 10 years to obtain her doctorate in psychology. Throughout this time, she maintained her connections to Alaska and Alaska Indian/Alaska Native people through summer psychology internships within the Alaskan tribal health system. Her full-time, predoctoral internship with Candace Fleming and postdoctoral position with Spero Manson at the University of Colorado Denver then focused on psychological services and research with indigenous peoples.

Dr. Dillard returned home to work with Southcentral Foundation in 2000 and has taken on a variety of roles in her service to the community. At Southcentral Foundation, she worked in clinical and administrative capacities, then completed the intensive 2-year Native Investigator research training program with Dedra Buchwald and Spero Manson before moving to research full-time. In 2008, she became the Southcentral Foundation Director of Research with a staff of 10; her staff has now grown to 25. Dr. Dillard has led a diverse portfolio of studies addressing the wide-ranging health and research needs of the American Indian and Alaska Native community served by the organization.

Dr. Dillard did not disclose any conflicts of interest for this workshop.