Differences in service utilization at an urban tribal health organization before and after Alzheimer's disease or related dementia diagnosis: A cohort study.

INTRODUCTION: The prevalence, mortality, and healthcare impact of Alaska Native and American Indian (ANAI) people with Alzheimer's disease and related dementias (ADRD) are unknown. METHODS: We conducted a cohort study of electronic health record data that compared healthcare service utilization in patients with and without an ADRD diagnosis. Zero-inflated negative binomial regression with robust standard errors was used to estimate utilization rates. RESULTS: Compared with patients without ADRD, utilization rates were similar before but higher after ADRD diagnosis. For those with diagnosed ADRD, utilization increased gradually over time with sharp upward change during the year of diagnosis. DISCUSSION: This is the only study quantifying changes in healthcare service utilization before and after ADRD diagnosis among ANAI people, which is crucial for tailoring geriatric care for ANAI populations.

Southcentral Foundation tobacco cessation initiative.

OBJECTIVES: To describe the development of a comprehensive tobacco cessation program for Alaska Native and American Indian patients in a primary care setting utilizing current evidence-based guidelines. STUDY DESIGN: Cross-sectional. METHODS: A multidisciplinary team was assembled with representation from various departments including customers of the health care system to develop the tobacco cessation program. Feedback and guidance from the team were implemented and quit rates were calculated. RESULTS: In April 2005 the point prevalence of quitting among the 322 patients enrolled in the tobacco cessation program for 6 months was 21.1%. CONCLUSIONS: Recognized clinical interventions that reduce tobacco use were effective in reducing tobacco use among the Alaska Native and American Indian patients enrolled in the tobacco cessation program. Initial results with respect to the quit rate and tobacco use screening rate provide a baseline for future work.

Pathways process evaluation results: a school-based prevention trial to promote healthful diet and physical activity in American Indian third, fourth, and fifth grade students.

BACKGROUND: Pathways was a large-scale, multisite, 3-year, study testing a school-based intervention designed to lower percent body fat in American Indian children. METHODS: At the 21 intervention schools process evaluation data were collected for training of school personnel; implementation of the classroom and physical activity curricula; implementation of the project's food service guidelines in the school cafeterias; adult participation in the family events; and, students' perceived exposure to the Pathways interventions. RESULTS: Students received about 93% of the classroom curriculum lessons. The minimum requirement of physical education being taught three times per week for at least 30 minutes duration was achieved by the fifth grade. The implementation of the food service behavioral guidelines increased from 51% in the third grade to 87% in the fifth grade. The family events had lower than anticipated adult participation. The participation rates were 45% during the third grade, and 41 and 63% during the fourth and fifth grades, respectively. There was a significant difference between intervention and control students' perceived exposure to Pathways type interventions. CONCLUSION: The Pathways interventions were successfully implemented with good reach, high extent, and fidelity.