The Indian Health Services (IHS) was originally a temporary agency started in 1955 to provide health care for eligible Native Americans, many with historically limited access to health care provided only by a small group of Public Health Service nurses assigned to reservations. As the native population grew, so did health disparities among indigenous peoples compared with the general United States population. Tribal leader concerns over this issue led to meetings in the 1950s between congressional delegates and tribal leaders looking for ways to extend health care service. The result of these meetings resulted in rural clinics and small hospitals built on or bordering reservations overseen by the newly formed IHS. The original model of care provided urgent care on a walk-in basis to manage acute illness and emergencies, but did not provide for either continuing care or specialty referrals. In 2005, IHS and tribal leaders again met to discuss widening disparities becoming evident as focus shifted from providing temporary fixes in the acute care setting to management of chronic disease, increased patient involvement in healthcare decision-making, and a growing emphasis on preventative care. A significant shift in providing primary care occurred with establishment of the primary care medical home (PCMH) in outpatient departments around the country where patients were assigned to a specific provider and healthcare team who would partner with them. IHS has a unique mission to provide evidence-based allopathic care in collaboration with traditional healing methods. The Institute for Healthcare Improvement (IHI) formulated a primary care model based on IHS’ specialized needs named Improving Patient Care (IPC) based on Wagner’s Chronic Care Model.
