Improving the Quality of Heart Failure Care for American Indian Patients Receiving Care through the Indian Health Service

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PROJECT SUMMARY/ABSTRACT Heart failure morbidity and mortality disproportionately impact racial minorities, and inequitable care delivery based on race is pervasive in the United States. While the American Indian/Alaska Native population is one of the populations that suffers most from health disparities, little is known about their burden of cardiovascular disease, particularly heart failure. In fact, there are no studies in the current era evaluating the burden and outcomes of heart failure among the American Indian/Alaska Native population, or the quality of care they receive. The proposed mixed-methods research plan aims to characterize the burden of disease, outcomes, and quality of care of American Indian/Alaska Native patients with heart failure with reduced ejection fraction receiving care through the Indian Health Service— the principal health care provider for the American Indian/Alaska Native population, as well as to determine implementation strategies to ensure quality heart failure care for this population. Aim 1 seeks to characterize the clinical characteristics, as well as rates of guideline directed medical and device therapy and outcomes of American Indian/Alaska Native patients with heart failure receiving care through the Indian Health Service. This aim will utilize a large administrative clinical and claims database. Aim 2 will augment this analyses by employing qualitative research methods to interview American Indian heart failure patients discharged after a heart failure hospitalization, as well as primary providers at two Indian Health Service sites in Navajo Nation to better understand barriers to quality heart failure care. Aim 3 will employ an implementation mapping approach with a stakeholder taskforce at the same sites to determine the highest priority strategies to improve heart failure care for this population. These aims will lead to a future pilot pragmatic clinical trial of American Indians with heart failure in Navajo Nation, which will be used to evaluate the effectiveness of the highest priority strategies to improve care identified in aim 3. These research aims are part of a comprehensive training plan and will be supervised by a mentorship and advisory team consisting of national leaders in health services and implementation science research, and advanced statistical and qualitative methodologies, and will guide my transition to an independently funded research career.