Lyle Ignace, MD, MPH

Lyle Ignace, MD, MPH

2009-2010

Executive Director, Gerald L Ignace Indian Health Center (GHLIIHC), Milwaukee, WI

A member of the Coeur D'Alene Tribe of Idaho, Dr. Ignace is currently the Chief of Internal Medicine, Navajo Service Unit, at the Gallup Indian Medical Center (GIMC), Gallup, NM.  He is a Public Health Service Civil Servant in the Department of Health and Human Services, Indian Health Service.  A long-standing member of the Association of American Indian Physicians (AAIP), he served on their executive board between 2000-2003 and again between 2007-2008.  He is also the principal clinical investigator for GIMC's Chronic Care Initiative.  This is a collaborative effort between The Institute of Health Care Improvement and the Indian Health Service to develop and implement a chronic care model that is designed to improve health care management and promote disease prevention for all Native Americans.
 
Dr. Ignace received his medical degree from the University of Minnesota School of Medicine in 1996 and completed his internal medicine residency at the Medical College of Wisconsin, Milwaukee, WI in 1999.

Indian Health Service: Evaluating the Chronic Care Initiative

Minorities and underserved populations continue to face unacceptably high rates of illness, disability and mortality from chronic and preventable conditions.  American Indian and Alaskan Natives adults are 2.7 times as likely as Non-Hispanic whites to be diagnosed with diabetes, mortality 2 times as likely as Non-Hispanic whites from diabetes and more likely to smoke, have high blood pressure, heart disease and obesity.  The Indian Health Service, an agency of the Department of Health and Human Service, implemented 3 initiatives in Health Promotion and Disease Prevention, Chronic Care, and Behavioral Health to reduce the health disparities and to improve the health status of all AI/AN cared for in the Indian Health system.

Methods:         

In 2007, the Chronic Care Initiative enrolled 14 pilot sites, called Innovations in Planned Care (IPCI) across IHS, Tribal and Urban Indian Health programs to develop and implement strategies to meet the health care services needs of AI/AN.  The IHS adopted the 6 key change concepts from the “Chronic Care Model” and in partnership with the Institute for HealthCare Improvement applied continuous improvement strategies to improve adult preventive care and screening process measures, management of chronic conditions, efficiency of clinical operations and patient experience of care by utilizing “microsystem” care teams.  In 2009, the CCI enrolled an additional 24 IPC (IPC II) sites to continue efforts and share in best practice methodologies to improving the delivery of care to AI/AN.

An IPC evaluation workgroup was established to determine if the Innovations in Planned Care (IPC) initiative are associated with improvement in the quality of care process measures?  Sixteen short term outcome Government Performance Reporting Act (GPRA) process measures were identified and single percent improvements associated with confidence intervals in forest chart and comparing the first 12 months from time of implementation for IPC I and IPC II sites.  In addition, was the performance on the selected (GPRA) measures at baseline by IPC I and IPC II significantly different than GPRA performance on these measures among all federal sites reporting GPRA measures.

Conclusion:   

Preliminary results would indicate IPC sites have shown improvement, however efforts will need to continue to assure all AI/AN receive the benefits from the early success in delivering quality health care with true value.  Qualitative interviews are being conducted at IPC sites to identify characteristics and activities that support successful implementation.

Preceptors:

Ty Reidhead, M.D., Institute for Healthcare Improvement Fellow, National Chief Clinical Consultant in Internal Medicine, Chair for Improving Patient Care Program, Indian Health Service

Yvette Roubideaux, M.D., MPH, Director of Indian Health Service, DHHS

Sponsoring Organization:

Department of Health and Human Service:  Indian Health Service