THPS/Data Improvement and Epidemiology

Data Improvement and Epidemiology

Established in 2000, the USET Tribal Epidemiology Center (TEC) monitors and reports on the health status of Tribal Nations to promote wellness and reduce disease. The USET TEC is one of 12 TECs established by Congress through the Indian Health Care Improvement Act (IHCIA) and funded by the Indian Health Service (IHS). As a designated Public Health Authority (P.L 94-437 through the Health Insurance Portability and Accountability Act [HIPAA]), the TEC supports Tribal communities in improving the health of Tribal citizens through seven core functions:

  1. Collect data relating to, and monitor progress made toward meeting, each of the health status objectives of the Tribal communities.
  2. Evaluate existing delivery systems, data systems, and other systems that impact the improvement of Tribal citizens' health.
  3. Assist Tribal communities in identifying the highest-priority health status objectives and the services needed to achieve those objectives, based on epidemiological data.
  4. Make recommendations for the targeting of services needed by the populations served.
  5. Make recommendations to improve health care delivery systems for Tribal communities.
  6. Provide requested technical assistance in the development of local health service priorities and incidence and prevalence rates of disease and other illnesses in the community.
  7. Provide disease surveillance and assist Tribal communities to promote public health.

Accurate data are vital to Tribal sovereignty, self-determination, and understanding the health of Tribal communities. Indian Country public health has long been neglected due to the failure of the United States to uphold the trust and treaty responsibilities and obligations to Tribal Nations. Publicly available state and federal data are often suppressed or collapse Tribal citizens into the “other” category due to small numbers and structural data racism. Health data held by Tribal Nations often do not include vital events (births and deaths) or healthcare accessed outside of primary care (emergency and specialty visits, and inpatient behavioral health). The TEC works to improve Tribal Nation data by providing training and support to Tribal clinics on documentation and data entry, accessing previously unavailable data (such as data held by state/federal agencies), and improving racial misclassification. The TEC provides data support in the following key areas:

COVID-19

TEC staff are providing epidemiological support throughout the COVID-19 pandemic to all federally recognized Tribal Nations in the IHS Nashville Area including:

  • Providing Tribal Nation-specific surveillance reports tracking trends for COVID-19 cases, deaths from COVID-19, and the administration of vaccines.
  • Developing and implementing a Tribal Nation-specific surveillance tool for tracking adverse events and contact tracing.
  • Building the capacity of Tribal Nations to adequately respond and support their communities.

Project ECHO (Extension for Community Healthcare Outcomes)

The TEC partnered with Project ECHO at the Northwest Portland Area Indian Health Board to bring together community health providers in a collaborative manner to help local workers share knowledge and gain the expertise required to provide needed services. TEC staff host bi-weekly webinars that incorporate case-based learning and mentorship around various topic areas, including COVID-19, hepatitis C, and Overdose Detection Mapping Application Program (ODMAP).

Government Performance and Results Act

The Government Performance and Results Act (GPRA) requires federal agencies to engage in performance management tasks such as setting goals, measuring results, and reporting their progress. IHS GPRA measures include clinical care performance measures such as care for patients with diabetes, cancer screening, immunization, behavioral health screening, and other prevention measures. Good performance on these GPRA measures improves the health status of our patients, contributes to the preservation of the IHS annual budget, and plays a role in the performance ratings of the IHS Director, IHS Area Directors, and providers. TEC staff work to improve GPRA data by providing training and support to Tribal Nation clinics in Electronic Health Record (EHR) data entry and patient flow by utilizing tools such as clinical reminders and iCare. The TEC staff conduct site visit evaluations to assist Tribal Nations in improving their patient care.

Immunizations

TEC staff work with state immunization registries to update records in local EHRs to improve the data that is available to Tribal Nations and the patient care they are able to provide. This project includes improving documentation for routine childhood, adolescent, adult, and influenza vaccinations.

Mortality

TEC staff strive to ascertain complete and accurate mortality data for Tribal Nations in the IHS Nashville Areaworking with federal, state, and Tribal entities. Data compiled from all sources are used to formulate a mortality report, which features aggregate level and Tribal Nation-specific mortality data. While working to maintain data sovereignty, this project aims to gather information about leading causes of death and the burden of disease. Additionally, these data are used to better tailor program planning and public health prevention efforts, and secure resources to support Tribal Nations’ public health.

Social Determinants of Health

TEC staff analyze factors that influence health outcomes, such as income, educational attainment, and housing, to inform interventions that address health inequalities.

Opioids

TEC staff work with stakeholders across multiple sectors, including emergency departments, funeral home directors, pharmacies, and medical providers who serve Tribal citizens, to identify data gaps specific to opioid use disorders. We work directly with Tribal Nations to conduct data flow analyses to understand how data from these varied sources are returned to local EHRs in a streamlined manner. Additionally, TEC staff provide training on racial misclassification among Native Americans and work with relevant stakeholders to implement activities to correct these data errors. This includes expanding data sharing linkages and comparison and matching of Tribal Nation datasets with state-level datasets. This work aims to improve data quality and availability for Tribal Nations in the IHS Nashville Area, which will allow for better-informed policies, programs, and practices that support opioid overdose prevention programs.

Evaluation

The TEC offers and employs a multitude of evaluation approaches. Evaluation is utilized in the design, implementation, and long-term assessment of the degrees to which programs are impacting Tribal Nation public health equity. The TEC also offers a variety of opportunities for Tribal Nations to share their own assessments of public health programs and encourages the use of storytelling, imagery, and other qualitative tools.