Ty Reidhead, MD
Chief Clinical Consultant in Internal Medicine
Indian Health Service

 “Originally I thought I was going to be a pulmonologist and then ended up working with the Indian Health Service for a few years and decided I didn’t want to go back to the specialty.”  (1:28)

My name is Ty Reidhead. I’m an internist for the Indian Health Service [IHS]. I’m the Chief Clinical Consultant in Internal Medicine for IHS, and I’m also a member of the Three Affiliated Tribes of North Dakota. I grew up in Arizona. I’ve worked for the Indian Health Service now for 10 years, and we started working with IHI about a year ago to begin our work to improve chronic condition care for the Indian Health Service. I work in the Whiteriver Indian Hospital which is in Whiteriver, Arizona, about three hours from any major facility, and at that hospital we serve about 15,000 patients from the Whiteriver Apache Tribe as well as Navajo and Hopi Tribes, different communities that are around the Whiteriver area. It’s a, in quotes, “comprehensive health care facility.” We have an emergency room; we have a birthing center, inpatient services, and outpatient clinics all under the same roof, as well as ambulatory surgery under the same roof.

Originally I thought I was going to be a pulmonologist and then ended up working with the Indian Health Service for a few years and decided I didn’t want to go back to the specialty. I ended up taking care of patients in the clinic and realized there was a real need for changes and improvements so that we had better continuity of care and such … and so I ended up down this path.

 “If you go out to any local health care facility, there will be diabetes educators.”  (1:07)

American Indians have — and I’m generalizing — there’s a higher incidence of diabetes, which has a huge effect on all the co-morbidities that go with that. So we have a lot of patients on dialysis and all those complications.

We have a large national program for the care of patients with diabetes and there’s been extra money devoted towards that, extra resources. If you go out to any local health care facility, there will be diabetes educators. There are registries and community programs that are geared specifically to improve the care of patients with diabetes and maybe even in some places to prevent diabetes. They recognize, both the leadership of the diabetes programs as well as the director of the IHS, a few years back, recognized that we have these improvements in diabetes and why are they not spreading to the other conditions that exist like cardiovascular disease, hypertension, depression? Why aren’t we seeing improvements in those? Because of that, we wanted to try and focus on how we could do better in those areas.

 “The best thing I like about it is the time that I spend with patients is going to be more geared towards what I need to do as a physician.”  (1:28)

We have an innovation right now, an innovation community that’s working right now to try to make improvements in planned care. And I think that’s one of the key drivers or core concepts of how I think we’re going to be able to make improvement is improving the relationship of patients with the care team. Right now in lots of areas of the Indian Health system, what happens is they tend to get focused on the acute care of patients, because of the specific demand of people coming into the emergency room and the urgent care, at the expense of paying attention to primary care relationships. So patients, when they have a need, they end up going to the emergency room for urgent care. So the focus of the innovation is to try to improve primary care teams and that relationship so that patients have somebody to see.

The best thing I like about it is the time that I spend with the patients is going to be more geared towards what I need to do as a physician, to be able to find out what’s really going on with the patient — what their needs are — and some of the other details that I typically would have been taking care of, other members of the team are going to be bringing in nutritionists, educators, and public health nurses that will help out in the community as well. Just the whole team approach I think is really what’s different.

 “The Indian Health system is full of providers who have been there for years and years… caring for native people and it really is a system that the whole United States could learn from.”  (1:04)

The Indian Health system is full of providers who, many have been there for years and years, including nurses and techs, who devote their whole careers to the Indian Health system and caring for native people. Those providers are great providers and the system that they work in, I think it’s a system that the whole United States could learn from. We hope that as we go through this, that we’re going to show that the Indian Health system, the structure and the quality of care that they deliver, really is a system that might be modeled because it has all the components: it has comprehensive health care, it has nurses that can interact with the community, all the components really of the care model. So I think that the Indian Health system is really a quality organization that provides good care, great care to American Indians, and a lot of American Indians prefer to go there because of that quality instead of going elsewhere.

08/03/2007