The Native American population experiences a disproportionate disease burden across a spectrum of conditions. While the National Healthcare Disparities Report highlights differences in quality of care among racial and ethnic groups, there is disappointingly little information presented on Native Americans. Of equal importance is the lack of information on patient experiences with the US health care system among Native Americans. In order to substantially improve care for Native people, we first need to understand the current state of health care for this population and to better characterize barriers to the delivery of high-quality care in the areas of the country that provide services for large Native populations. As the largest single care provider for Native Americans, the Indian Health Service (IHS) represents an integral component of the health care delivery system for many Native patients, and this federal health care program is currently undergoing substantial changes designed to measure and improve quality of care.

Using an innovative combination of data from both federal and nonfederal sources, this study has the following four specific aims:

• use the information systems within the IHS to generate quality-of-care measures for preventive services and chronic disease care; identify high- and low-performing geographic regions within the HIS; and benchmark this care to performance within the Medicare program;
  
• identify local barriers to quality improvement within the IHS through physician surveys and relate these findings to regional variation in performance measures;
  
• assess the potential importance of innovative information technology on quality improvement within the IHS by measuring the impact of a telemedicine project on rates of diabetic retinopathy screening examinations;
  
• compare patient ratings and reports of health care experiences for Native Americans receiving care within the IHS, Medicare, Medicaid, and commercial health plans; and compare similar ratings and reports between Native Americans and whites within Medicare, Medicaid, and commercial health plans.