ARRA ACTION: Comparative Effectiveness of Health Care Delivery Systems for American Indians and Alaska Natives Using Enhanced Data Infrastructure

IHS Improving Health Care Delivery Data Project Collaboration

The IHS Improving Health Care Delivery Data Project was sponsored and guided by the IHS Division of Diabetes Treatment and Prevention (DDTP), the Pharmacy Program, and the Office of Information Technology (OIT). Collaboration with IHS and Tribes was a vital component of the IHS Data Project. To facilitate project implementation and success, three project committees were formed. The first committee, the Project Planning Group, included IHS senior leadership (i.e., DDTP Acting Director, Chief Pharmacy Officer) and CAIANH senior research personnel. Its goal was to coordinate project implementation, with guidance from the two other committees, and advise CAIANH on setting project priorities.

The Steering Committee included representatives from IHS DDTP, Pharmacy Program, and Office of Information Technology; two IHS Area chief medical officers; and representatives from several Tribal health organizations (i.e., the Diabetes Tribal Leaders Committee, the Centers for Medicare and Medicaid Services [CMS] Tribal Technical Advisory Group, a Tribal epidemiology center). In addition to providing general guidance and advice, as described above, committee members advised on potential use of results at the local and national levels within IHS and across other agencies (e.g., CMS), and provided assistance with general problem solving.

The Health Information Committee included health care providers and administrators from each project site. They provided general guidance and advice, as well as specific information on their project site. Our collaboration with project sites included ongoing communication via email and phone, an average of three site visits to each project site, and the development of site-specific reports and data sets for use by project site personnel. During the site visits, we were able to meet with the project site representatives to discuss the project; learn about their service systems, patient populations, and priorities for project analyses; and collaborate on the development of project health status, service utilization, and cost measures. The Health Information Committee provided guidance on data measures, data analysis and interpretation, design of site-specific reports, and assistance with scheduling trips to consult with I/T representatives. Both the Health Information and Steering Committees met quarterly via Webinars.

CAIANH conducted a training program to provide technical assistance on the development of the data infrastructure and options for analyzing project data, including training on SPSS, in July 2012 at the Colorado School of Public Health. Representatives from the IHS Pharmacy Program, IHS DDTP, and five project sites attended the training.^d At the conclusion of the project, copies of the data infrastructure were provided to IHS. For project sites that requested them, copies of data infrastructure analytic files for their project site’s population were provided.

In July 2012, we conducted several Webinars to review the development of project’s data measures and algorithms used to process the data, prior to finalizing the measures. Members of the Steering and Health Information Committees participated in the Webinars; the guidance provided by committee members was used to modify and finalize the measures and algorithms.

Project Implementation Timeline and Milestones

Project implementation was dependent upon a number of project milestones. They are listed below with information on completion dates.

1. The Project Planning Group identified 14 project sites (i.e., Service Units) to invite to participate in the project, based on a number of factors including population size, how well the Service Unit represented the IHS Area, quality of the service utilization and cost data, organizational type (e.g., IHS or Tribal), service system characteristics, and willingness and ability to participate. At least one project site was identified in each of the 12 IHS Areas. Due to population size, two were identified in the Navajo and Oklahoma Areas, for a total of 14 project sites. The selections were reviewed and approved by the Steering Committee. IHS invited the sites to participate in the project in June 2011.
2. The IHS National Institutional Review Board (IRB) provided project approval in August 2011. The Colorado Multiple Institution Review Board, the University’s IRB, provided approval in July 2011. IHS signed a Data Use Agreement with the University in September 2011. CAIANH obtained Tribal IRB and Tribal Council approvals for project participation.^e
3. CAIANH conducted site visits to each project site to discuss project participation.
4. OIT provided CAIANH information on the NDW tables and data elements. CAIANH submitted a data request to OIT and obtained data extracts for FY2007-2010 in late December 2011. The data were resent early January 2012. After a number of data testing steps were conducted, CAIANH initiated data analysis in January 2012. During 2012 CAIANH was provided additional data extracts from the NDW, the fiscal intermediary for CHS, and the IHS National Supply Service Center.
5. CAIANH conducted, on average, two additional site visits to each site to discuss the development of data measures, review preliminary findings, discuss potential changes to the measures and additional data analyses, and interpret final project findings.

CAIANH obtained the NDW extracts during month 16 of a project funded for 24 months. In the original project plan, the number of months allocated for data analysis and reporting was 18. For reasons noted above, there were less than 9 months. Thus, project timeframes limited the number and complexity of analyses.

CAIANH provided each project site a report with findings for the project site’s population.^f The tables in these reports were provided as Excel files to the project sites so that the sites could use the tables in PowerPoint presentations, other reports, and grant applications. Seven of the 14 project sites requested and were provided a set of data mart tables with data for their project site’s population.

^dRepresentatives from all 14 Service Units were invited to attend. However, the availability of travel funds limited participation by many project sites.
^eTribal Council approval was provided by means of a resolution in support of the project or a letter from a Tribal Council representative. For two of the Service Units, the Tribal Council did not provide approval by the end of the project. Consequently, it is not possible for project staff to conduct data analyses for these Service Units in separate analyses, or to provide site-specific reports for the Service Units. The IHS National IRB provides approval to use the data for these Service Units in analyses that include data for all 14 Service Units.
^fThe site-specific reports and Excel tables were provided in 2012. As part of the review of this final project report, a limited number of data enhancements were made to the data infrastructure. Consequently, the results reported for each site in this final report may have minor differences from those reported in 2012.