healthcare in indian country and wound care...morongo casino resort and spa cabazon, ca october 8,...
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Native American Wound Care Conference
Morongo Casino Resort and SpaCabazon, CA
October 8, 2012
Donald Warne, MD, MPHOglala Lakota
Healthcare in Indian Country and Wound Care
Overview
American Indian Health Disparities
Diabetes, Wound Care, Amputations, Disabilities
Levels of Prevention
American Indian Health System
Complexities in Coordinating Care
Need for an Organized Approach to Wound Healing
Reasons Why Patients Go On To Amputations
Diabetes Disparities
Numerous Co-Morbidities
Non-compliance / Barriers to Services
Socio-economic factors
Complex Indian Health System
Diabetes Life Line
Gestational Diabetes
Birth
Obesity IGT
Diabetes Complications Death
Prevention
Model
Resources
Primary Secondary Tertiary
Public Health Medical
$ $$ $$$
Diabetes Death Rates (Rate Per 100,000 Population)
25.2
77.7
119.9
0
20
40
60
80
100
120
US All Races IHS Total Aberdeen
0%5%
10%15%20%25%30%35%40%
2005 2006 2007 2008 2009
Diabetes Prevalence for 55 Years and Older
White American Indian
SD:
Diabetes Prevalence by RaceNorth Dakota Adults 2005-2008
6.5
12.6
0
5
10
15
White American Indian
Source: Behavioral Risk Factor Surveillance System
Perc
enta
ge o
f Ad
ults
Diabetes Mortality Rate by Race North Dakota 2000-2007
25.4
144.2
0
50
100
150
White American Indian
Source: North Dakota Vital Records
Age-
Adju
sted
Mor
talit
y Ra
te
Per
100,
000
Popu
lati
on
Why Patients Go on to Amputations
Risk Factors:•Diabetes•Obesity•Smoking•Alcohol
Poor Circulation & Neuropathy
Poor Access to Services
0%
10%
20%
30%
40%
50%
2005 2006 2007 2008 2009
Obesity Prevalence
White American IndianData source: BRFSS
SD:
Smoking Disparities by State
Alcohol Related Death Rates(Rate/Per 100,000 Population)
Percent At or Below FPL2000 Census
0
5
10
15
20
25
30
35
40
45
50
US All Races IHS Total Aberdeen
10/15/2012
2009 IHS Expenditures Per Capita and Other Federal Health Care Expenditures Per Capita
$11,
018
$6,7
32
$6,1
30
$5,1
63
$4,8
17
$3,2
42
$2,6
96
-
-
-
--
-
-
$-
$2,000
$4,000
$6,000
$8,000
$10,000
Medicare per beneficiary
National Health Expenditures
Veterans Administration
Medicaid per enrollee
FEHB Medical Benchmark
Medical for Federal Prisons
>decade old
Indian Health Service
2009 20092007 19992008
Per Capita spending in the year for which data are published most recently – see base of each bar.
$648
IHSMedical
IHSOther
See page 2 notes on reverse for data sources and extrapolation assumptions.
2007
2009
Indian Health System 1955-1975
IHS
Federal
Indian Health System 1975-1988
IHS
FederalPL 93-638
Tribal
IHS
Federal
PL 93-638
Tribal
Medicaid
State
AI HealthcareConsumer
Indian Health System
Health Sector
Need for an Organized Approach to Wound Healing
Decrease Cost of Care
Limb Salvage
Availability of New Technologies
Decrease Disability Lost Productivity, Lost Self-sufficiency Increased Medical and LTC Costs
Improve Quality of Life
