Recorded presentation

Carol C. Korenbrot, PhD¹, Chi Kao, PhD¹, and James Crouch, MPH². (1) Institute for Health Policy Studies, University of California San Francisco, Box 0936, San Francisco, CA 94143-0936, 415/476-3094, ckoren@itsa.ucsf.edu, (2) Executive Director, California Rural Indian Health Board, 1451 River Park Drive, Suite 220, Sacramento, CA 95815

Enhanced sovereignty and devolution of the Indian Health Service (IHS) have increased the health care systems run by tribes. Most California tribes operate health programs for ambulatory care though there are no tribal or IHS hospitals. One way the programs have found to evaluate care is through disparities in Avoidable Hospitalizations (AH), an indicator of timeliness and effectiveness of ambulatory care. Our study was to determine whether there were any changes in disparities in AH for AIAN using non-urban tribal clinics relative to those of whites living in the same counties. We found that disparities in hospitalizations preventable with timely and effective ambulatory care are declining for AIAN who use tribal health programs in California. California hospital discharge data for 1998 to 2001 was linked to IHS Active User data (average 45,670 Users annually, total 2,152 AH) and compared to a random sample of hospitalizations for whites (average 89,225 people annually, total 4,334 AH). Risk Ratios of age-adjusted rates and their 95% confidence intervals were determined. AH risk ratios for AIAN declined gradually from 57% higher than whites in 1998 (RR 1.57; CI 1.41, 1.73) to 40% higher in 2001 (RR 1.40; CI 1.28, 1.53). In each case the point estimate is outside the confidence interval of the other ratio. Community and individual level factors are now being investigated for their contribution to the decline using multilevel linear models that include such factors as increased IHS funding, improved GPRA performance indicators, and changes in access and socioeconomic indicators.

Learning Objectives:

• To understand the importance of disparities in Avoidable Hospitalizations as an indicator of timeliness and effectiveness of ambulatory care for AIAN.
• To know that AIAN using tribal health clinics in California have experienced a reduction in their disparity of being hospitalized unnecessarily.
• To understand what community, individual and program factors in the AIAN communities with tribal health programs contributed significantly to this reduction.

Keywords: American Indians, Quality

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation