Comprehensive Geriatric Care of
Elderly Native Americans
Miriam E. Schwartz
Department of Family Medicine
Gallup Indian Medical Center (GIMC)
Gallup, New Mexico 87301
Indian Health Service (IHS)
• United States Department of Health and
Human Services
• The main federal health program for
American Indians and Alaska Natives
• Provides health services to about 1.8
million Native Americans who belong to
approximately 557 federally recognized
tribes in 35 states
The Navajo Nation
The Navajo Nation
The Navajo Nation
• Window Rock, Arizona – The Capital
Gallup Indian Medical Center
• Located in Gallup, New Mexico about
5 miles from the Navajo Nation border
• Hospital with 99 beds
• Clinical Specialties include – Family
Medicine, Internal Medicine, Pediatrics,
General Surgery, Orthopedics, ENT,
Radiology, Pathology, Emergency
Medicine, Psychiatry, Dental, OB/GYN
Gallup Indian Medical Center
• Serves mostly the Navajo Tribe
Gallup Indian Medical Center
• The workload at Gallup is one of the largest
in the Indian Health Service
• Enrolled number of patients –
43,000 individuals
• Annually - 250,000 outpatient encounters
and 5,800 inpatient admissions
• The largest staff of all Navajo Area IHS
facilities
Nature of Problem
• Prior to November 2007 - there was no
organized geriatric care for the elderly
patients at GIMC, but the need is great
because our elderly population have unique
characteristics given their cultural beliefs,
traditions, and environmental situations.
Mission and Vision of GIMC
• Mission:
We will provide health services with –
Compassion
Accessibility
Respect
Excellence
Mission and Vision of GIMC
• Vision:
We value our patients and the community.
We will work to see that they value us.
We will generate the revenue to maximize services.
We will use resources judiciously.
We will support patient and family involvement,
education, and decision making.
We will have consistency between our plans and our
actions.
Results of Environmental Scan
• Paucity of data about care of elderly Native
Americans
• Comprehensive Geriatric Assessment
(CGA) and screening tools need to be
modified to fit the culture and traditions of
the target patient population
Approach to the Problem
•
Geriatric Interdisciplinary Programs
1.
2.
3.
4.
5.
6.
Comprehensive Geriatric Assessment
Fall Risk Reduction Clinic
Fall Injury Prevention Program
Case Management of High Risk Patients
Caregiver Support
Financial Sustainability
Target Population
• How will you identify?
– Patients are referred by Primary Care Physicians,
Emergency Department Physicians, Urgent Care Clinic
Physicians, and other Health Care Professionals.
• Any unique attributes or cultural concerns?
– Native American culture
• Navajo Tribe (majority of patients)
• Hopi
• Zuni
• Acoma
– Traditional Medicine
Process and Outcome Measures
• Process
– Comprehensive Geriatric Assessment
– Fall Risk Evaluation
• Outcome Measures
– Next Slide
• Collection of Data
– Data Collector
Process and Outcome Measures
• Outcome Measures
–
–
–
–
–
–
–
Nursing Home Admissions
Morbidity Rate
Mortality Rate
Health Benefits
Functional Status
Caregiver Burden
Financial Sustainability
Project Timeline
• December 2008
• Data available for the following
–
–
–
–
Morbidity Rate
Nursing Home Admissions
Functional Status
Mortality Rate
Project Timeline
• June 2009
• In addition to the previous outcome
measures
• Data will be available for the following
– Health Benefits
– Caregiver Burden
– Financial Sustainability
Implementing the Program
• The geriatric interdisciplinary program at GIMC is
already at its nascent state.
• Interdisciplinary team members – dental assistants,
dietitians, nurses (case manager, podiatry & surgical),
physical therapist, optometrist, physician assistant,
and social workers.
• There are no new opportunities onto which the
program was attached. We started the program.
Implementing the Program
• Who are the key stakeholders?
–
–
–
–
Department of Family Medicine
Urgent Care Clinic
Emergency Department
Other Departments
• How do you plan to engage them?
– Meetings with chiefs of departments initially
and asking for their suggestions
– Implementation of these suggestions
Perceived Facilitators/Barriers
• Facilitators
– Geriatric Interdisciplinary Team Members
– Department of Family Medicine
– Other Departments
Perceived Facilitators/Barriers
• Barriers
– Integration of this new service line into the business
structure of the institution
– Negotiation of service agreements with other
departments
– Development of measures that show improvement in
geriatric care and outcomes that are sustainable in a
constrained fiscal environment
– Local politics and bureaucracy in the institution
– Some cultural aspects of care
Preliminary Data
Month
Patients seen in
CGA Clinic
November 2007 No clinic yet
Patients seen for
Fall Assessment
4
December 2007 14
1
January 2008
4
6
February 2008
18
5
March 2008
9
5
Preliminary Data
Month
April 2008
Patients seen in
CGA Clinic
8
Patients seen for
Fall Assessment
4
May 2008
No clinic
5
June 2008
No clinic
No clinic
July 2008
10
5
August 2008
11
2
Preliminary Data
Month
Patients seen in
CGA Clinic
September 2008 6
Patients seen for
Fall Assessment
6
October 2008
(7 scheduled)
(23 scheduled)
November 2008 No schedule yet No schedule yet
December 2008 No schedule yet No schedule yet
Total seen
80
43
Sustaining the Program
• Meticulous accounting of billing and coding
for the geriatric clinics
- following the financial aspects of care will
be absolutely necessary for our program
What I Have Learned
• Cultural sensitivity for the target population
is important in any project.
• Local politics and bureaucracy in the
institution are significant factors in any
project.
• Engaging and motivating the key stake
holders and participants are essential
elements of any new project.
References
• Indian Health Service Web Site –
www.ihs.gov
• Source of Photos
www.ihs.gov
Thank you for your attention!
Thank you very much
for your support
graciousness and
encouragement !!!