ACTIVITY / MECHANISM BUDGET SUMMARY

Department of Health and Human Services

Indian Health Service -- 75-0390-0-1-551

HEALTH EDUCATION

[Program Authorization]{.underline}: Program authorized by 25 U.S.C. 13,
Snyder Act, and\
P.L. 83-568, Transfer Act 42 U.S.C. 2001.

+--------------+------------+-------------+------------+-------------+
| []{.mark}    | **2003     | **2004**    | **2005     | *           |
|              | Actual**   | **Enacted** | Estimate** | *Increase** |
|              |            |             |            |             |
|              |            |             |            | **or        |
|              |            |             |            | Decrease**  |
+--------------+------------+-------------+------------+-------------+
| **BA**       | \$         | \           | \$         | \+          |
|              | 10,991,000 | $11,793,000 | 12,633,000 | \$840,000   |
+--------------+------------+-------------+------------+-------------+
| **FTE**      | **25**     | **37**      | **39**     | **+ 2**     |
+--------------+------------+-------------+------------+-------------+
|              |            |             |            |             |
+--------------+------------+-------------+------------+-------------+
| HIV-AIDS     | (          | (\$535,000) | (          | 0           |
| (\$)         | \$535,000) |             | \$535,000) |             |
+--------------+------------+-------------+------------+-------------+
| HIV-AIDS FTE | \(1\)      | \(1\)       | \(1\)      | 0           |
+--------------+------------+-------------+------------+-------------+
|              |            |             |            |             |
+--------------+------------+-------------+------------+-------------+
| Health       | 596,100    | 588,947     | 565,389    | -23,558     |
| Education    |            |             |            |             |
| Services     |            |             |            |             |
| Provided     |            |             |            |             |
+--------------+------------+-------------+------------+-------------+

**[PURPOSE AND METHOD OF OPERATION]{.underline}**

##### Program Mission and Responsibilities

The Indian Health Service (IHS) Health Education program communicates
the importance and on-going need of health education and health literacy
to improve health promotion and disease prevention among American Indian
and Alaska Native communities. A new IHS-wide policy circular
integrating education and literacy in daily practices by all disciplines
and programs was approved. While statistics indicate a decline in the
number of I/T/U sites employing a full-time health educator, RPMS
statistics, as well as GPRA data, indicate a steady rise and increase in
the educational encounters that are being provided to Native American
and Alaskan Native clients. This further demonstrates the collaboration
between the IHS Health Education Program and all IHS health disciplines
and programs. Recognizing that the resulting decline in health education
positions does not alleviate the IHS Health Education Program from the
ongoing mission and responsibility to provide health literacy and
education to Native American and Alaskan Native clients, the IHS Health
Education program spear-headed an agency-wide initiative to ensure the
provision of education to Native American and Alaska Native clients by
all I/T/U staff. To accomplish this renewed focus on literacy and
education, all disciplines and programs are being required to focus a
more determined effort towards the continuation and ongoing need to
ensure the provision of education and to raise the levels of health
literacy. Three specific mechanisms targeting education were developed
and/or refined to track the delivery of education that is being provided
within IHS: RPMS, ORYX, and GPRA+. Additionally, the
[www.ihs.gov](http://www.ihs.gov/) website includes the IHS Patient
Education Protocols/Codes.

The IHS Health Education program is committed to a partnership with
American Indian and Alaska Native communities to raise the health status
of American Indians and Alaska Natives to the highest possible level.
This is accomplished through education, leadership and promoting
community capacity building that nurtures healthy lifestyles and
utilization of health services. As evidenced by the large number of
Health Education Programs that have been compacted and contracted by
Tribes, the Health Education program continues to foster participation
of American Indian and Alaska Native communities in developing and
managing programs to meet their health priorities.

Within IHS, the core practice of public health education occurs in these
settings: community health, school health, worksite health promotion,
and patient education. The IHS Health Education program assists our
partners to engage in community-based prevention activities, such as
tobacco cessation, diabetes education, Sudden Infant Death Syndrome
(SIDS) education, and cardiovascular disease education. **The Health
Education Program has identified these priorities**:

-   To continue to develop and strengthen a standardized, nationwide
    patient and health education program as evidenced by the integration
    of the IHS Patient Education Protocols-Codes (PEP-C) into all
    clinical software packages within the IHS. Current RPMS software
    packages containing the IHS Patient Education Protocols/Codes
    (PEP-C) are: the Public Health Nurse, Behavioral Health, Diabetes,
    Pharmacy, and Laboratory software reporting systems as well as the
    proposed new obstetrical software package;

-   To enhance the capacity of those schools that educate American
    Indian and Alaska Natives to respond to issues of youth health as
    evidenced by the partnership in school nursing and comprehensive
    school health Memorandum of Agreement with the Bureau of Indians
    Office of Indian Education;

-   To support diabetes education through partnership with the IHS
    Diabetes Program in the development of the new IHS Diabetes
    Curriculum;

-   To increase the focus on the area of literacy in health and patient
    education through the use of a standardized assessment tool and to
    track that progress via RPMS;

-   And to research the efficacy of education by I/T/U clients via
    computerized kiosks in I/T/U waiting rooms.

-   To provide a renewed emphasis on tobacco education to all I/T/U
    sites.

To accomplish these activities **partnerships** have been developed with
health programs, tribes, schools, communities, educational institutions,
and public and private foundations.

The IHS Health Education Program has a long history of serving as a
benchmark and Federal model of health education services. It is one of
the few health education programs nationally that serves such diverse
health education needs working with over 500 tribal entities. The Health
Education Program has diligently continued to refine and improve on the
IHS Patient and Family Education Protocols and Codes. Among the many
successes of this project is the fact that outcome measurement can be
obtained for health education services to meet the **Joint Commission on
Accreditation of Healthcare Organizations (JCAHO)** standards for
health/patient education.

FY 2003 ORYX indicators have also been developed to track education in
our hospitals, clinics and community programs on cardiovascular disease
education, diabetes education on diet and exercise, tobacco cessation,
breast-feeding, and the education provided on medications. FY 2003 ORYX
Indicators results:

  ------------------------ ------------------- ---------------------------
  **ORYX Indicators for                        
  Education Encounters**                       

                           **FY 2001**         **FY 2003**

  Cardiovascular Education New Indicator in    Baseline: No Data available
                           '03                 yet

  Diabetes Education on    80,436              241,308
  Exercise and Diet                            

  Breast-Feeding           3,469               5,399

  Education on Medication  401,829             1,693,899
  Use                                          

  Tobacco Education        8,854               14,736
  ------------------------ ------------------- ---------------------------

**Health Education Program needs**:

-   To continue to provide ongoing training to I/T/U staff on the
    documentation and coding of education

-   To continue to **refine the GPRA+ and PCC+ software** to track
    education and literacy

-   To provide technical assistance to sites that would like to
    participate in reporting via the HERMS

-   To provide One Patient Education Documentation and Coding Training
    to the Billings, Navajo, and Phoenix Areas in FY 2005

-   To provide 2 Health Education Projects in the amount of \$100,000
    each to those sites already employing a full-time health educator

**[ACCOMPLISHMENTS]{.underline}**

During FY 2005, the IHS will continue collaboration with AI/AN
communities to implement culturally sensitive community-directed pilot
cardiovascular disease prevention programs including implementation of
primary prevention indicators and selection of behavioral and clinical
measures for tracking baseline data by each Tribal site. GPRA+ Baseline
data on five of the original seven sites is comprehensive and available.

-   The IHS Patient Education Protocols and Code Manual is reviewed on
    an annual basis and is included in the IHS Standard Book of Codes.
    To meet new health threats, education Protocols were added that
    include: SARS, West Nile Virus, and bio-terrorism.

-   New educational assessment codes have been added to the RPMS/PCC
    system.

-   The IHS Health Education Program will assist to expand the
    **cardiovascular disease Training** specifically within the
    Albuquerque and Billings Areas by funding additional sites to
    provide community-directed cardiovascular disease programs.

-   **A performance indicator on lipid screening** **moved from
    developmental status to actual GPRA + status.**

-   The Health Education Program will establish a baseline of tobacco
    statistics from which the Health Education Program will then
    collaborate with I/T/U clinical programs to increase the number of
    clinical interventions concerning tobacco.

-   The IHS Health Education Program will improve collaboration on
    school health with BIA Native American schools through assistance in
    the employment of a school nurse coordinator for BIA schools.

-   The IHS Health Education Program will increase prevention through
    education by 10 percent.

  ---------------- ---------- -------------- -- ---------------- ---------- --------------
  **IHS Health                                                              
  Education                                                                 
  *Clients* Served                                                          
  by Location\***                                                           

  **FY 2002**                                   **FY 2003**                 

  Location         Number of  Percent           Location         Number of  Percent
                   Clients    Distribution                       Clients    Distribution

  Total Clients    696,061    100.00            Total Clients    812,301    100.0

  Hospital         445,842    64.1              Hospital         534,891    65.8

  Health Center    225,618    32.4              Health Center    253,526    31.2

  Health Station   17,515     2.5               Health Station   16,271     2.0

  Location         6,339      0.9               Location         6,719      0.8

  Village Clinic   510        0.1               Village Clinic   700        0.1

  School Health    189        0.0               School Health    157        0.0
  Center                                        Center                      

  Administration   13         0.0               Administration   37         0.0

  \* Table 6.25                                                             
  IHS RPMS/PCC                                                              
  Data: Number of                                                           
  Clients that                                                              
  received                                                                  
  Education                                                                 
  ---------------- ---------- -------------- -- ---------------- ---------- --------------

  ----------------------------------- -----------------------------------
  **IHS-wide Patient and Family       
  *Education Encounters* by Fiscal    
  Year\***                            

  1998                                ±100,000 Encounters

  1999                                ±550,000 Encounters

  2000                                ±900,000 Encounters

  2001                                ±1,300,000 Encounters

  2002                                ±1,600,000 Encounters

  2003                                ±1,400,000 Encounters \* (as of
                                      8/11/03)

  \* From all RPMS/PCC Data received  
  by the ORYX Program as of August    
  11, 2003: Client may have 1 visit   
  but may receive education from more 
  than one provider or may be         
  educated on more than one topic.    
  ----------------------------------- -----------------------------------

#### **PERFORMANCE MEASURES**

The Health Education budget contributes to the accomplishment of the
following FY 2005 GPRA performance measures:

[Indicator 2]{.underline}: During FY 2005, maintain the proportion of
patients with diagnosed diabetes that have demonstrated improved
glycemic control at the FY 2004 level.

[Indicator 3:]{.underline} During FY 2005, maintain the proportion of
patients with diagnosed diabetes who have achieved blood pressure
control at the 2004 level.

[Indicator 7]{.underline}: During FY 2005, maintain the proportion of
eligible women who have had a Pap screen within the previous three years
at the FY 2004 levels.

[Indicator 8]{.underline}: During FY 2005, maintain the proportion of
eligible women who have had mammography screening at the FY 2004 rate.

[Indicator 23]{.underline}: During FY 2005, maintain baseline rates for
recommended immunizations for American Indian and Alaska Native children
19-35 mos.

[Indicator 24]{.underline}: In FY 2005, maintain the FY 2004 rate for
influenza vaccination levels among non-institutionalized adult patients
age 65 years and older.

[Indicator 25]{.underline}: In FY 2003, maintain the FY 20042 rate for
pneumococcal vaccination levels among non-institutionalized adult
patients age 65 years and older.

[Indicator 27]{.underline}: During FY 2005, reduce deaths caused by
unintentional injuries to no higher than the FY 2004 level.

[Indicator 29]{.underline}: During FY 2005, establish the number of
adult patients that receive appropriate screening for blood lipids.

Following are the funding levels for the last 5 fiscal years:

+-----------+---------------------+------------------------------------+
| # Year    | **[Fun              | **[FTE]{.underline}**              |
|           | ding]{.underline}** |                                    |
+-----------+---------------------+------------------------------------+
| 2000      | \$9,625,000         | 35                                 |
+-----------+---------------------+------------------------------------+
| 2001      | \$10,063,000        | 31                                 |
+-----------+---------------------+------------------------------------+
| 2002      | \$10,628,000        | 30                                 |
+-----------+---------------------+------------------------------------+
| 2003      | \$10,991,000        | 25                                 |
+-----------+---------------------+------------------------------------+
| 2004      | \$11,793,000        | 37 Enacted                         |
+-----------+---------------------+------------------------------------+

**[RATIONALE FOR BUDGET REQUEST]{.underline}**

**TOTAL REQUEST** \-- The request of \$12,633,000 and 39 FTE is a net
increase of \$840,000 and 2 FTE over the FY 2004 Enacted of \$11,793,000
and 37 FTE. The increase includes the following:

**[Pay Cost Increase: +\$266,000]{.underline}**

The request of \$266,000 will fund federal and tribal pay costs which
will assist the IHS in maintaining access to services for the IHS
patient population. Provision of these funds is necessary to maintain
the current I/T/U health system which works to eliminate disparities in
health status between the American Indian and Alaska Native population
and the rest of the U.S.

**[Phasing-In of Staff for New Facilities: +\$574,000 and 2
FTE]{.underline}**

This request provides for the phasing-in of staff and related costs for
new facilities allowing IHS to expand services in areas where existing
capacity is most over extended. The staffing of new facilities also
contributes to the recruitment and retention of medical staff and
promotes self-determination activities. The following table displays the
requested increase.

+--------------------------------+---------------+---------+---------+
| **Facilities**                 | **Dollars**   | **FTE** | **T     |
|                                |               |         | ribal** |
+--------------------------------+---------------+---------+---------+
| Westside, AZ Health Center     | \$115,000     | 1       | 0       |
|                                |               |         |         |
| Dulce, NM Health Center        | 115,000       | 1       | 0       |
|                                |               |         |         |
| Metlakatla, AK Health Center   | 115,000       | 0       | 1       |
|                                |               |         |         |
| Pinon, AZ Health Center        | 0             | 0       | 0       |
|                                |               |         |         |
| [Idabel, OK Health             | [229,000      | [       | [       |
| Center]{.underline}            | ]{.underline} | 0]{.und | 2]{.und |
|                                |               | erline} | erline} |
| **Total**                      | **\$574,000** |         |         |
|                                |               | **2**   | **3**   |
+--------------------------------+---------------+---------+---------+