Health Care and Satellite Radio Communication in Village Alaska

DOCUMENT RESUME ED 094.721 IR 000 917 AUTHOR Kreimer, Osvaldo; And Others TITLE Health Care and Satellite Radio Communication in Village Alaska. Final Report of the ATS-1 Biomedical Satellite Experiment Evaluation. INSTITUTION Lister Hill National Center for Biomedical Communications, Bethesda, Md.; Stanford Univ., Calif. Inst. for Communication Research. SPONS AGENCY National Library of Medicine (DHEW), Bethesda, Md. PUB DATE Jun 74 NOTE 429p. EDRS PRICE MF-$0.75 HC-$21.00 PLUS POSTAGE DESCRIPTORS *Communication Satellites; Equipment Evaluation; Health Conditions; Health Education; Health Facilities; Health Needs; Health Programs; *Health Services; Medical Evaluation; Medical Services; *Program Evaluation; *Radio; Telecommunication IDENTIFIERS *Alaska; ATS 1; Health Aides ABSTRACT The executive summary is the first section of this final report of the evaluation of the ATS-1 medical communication system in Alaska. The second section introduces the background of these studies and the sociogeographic setting and health situation of the Alaska natives. The third section presents the main research findings about both the aides-to-doctor and doctor-to-doctor exchanges, about use of the system for medical education, and about its social impact on Bush Alaska. A fourth section is devoted to a cost analysis of alternative systems and recommendations. The attachments (charts, tables, data gathering instruments, etc.). comprise a fifth section. (WCM) HEALTH CARE AND SATELLITERADIO commuNICATION IN V1ILACE ALASKA Final Report of the ATS-I Biomedical Satellite Experiment Evaluation a report of the INSTITUTE FOR COMMUNICATION RESEARCH STANFORD UNIVERSITY U S DERARTN5ENIOf HEALTM. EVOCATION & WELFARE NATION AL INSTItutE Of COUCATiON 0C7C. VINT rya'., ;LEN REPRO 0 ExaCILY RECtrvED FROM ,At s't RSON CR OR3AN,ZATION ORIGIN ! NT y CO. OR OPINIONS "ail C., PO NO' V if 55AR,LY RE PRE N' INSTITUTE Of 0,)( ON PCS, !ION CR POLiCt HEALTH CARE AND SATELLITE RADIO COMMUNICATION IN VILLAGE ALASKA Final Report of the ATS-1 Biomedical Satellite Experiment Evaluation By Osvaldo Kreimer with the collaboration of Heather Hudson and Dennis Foote, and including a Course Evaluation by Virginia Bunn Fowkes and an Evaluation of Future Communication Systems by Bruce Lusignan and Michael Sites Research supported by Research Contract NO1-LM-1-4718 between Stanford University and the National Library of Medicine Principal Investigators: William Fowkes, M.D. Bruce Lusignan, Ph.D. Edwin Parker, Ph.D. June 1974 INSTITUTE FOR COMMUNICATION RESEARCH - STANFORD UNIVERSITY and THE LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNICATION ALASKA LOCATIONS WITH ATS-1 GROUND STATIONS 1 Allakaket 2Anaktuvuk Pa:s 3 Anchorage 4 Arctic Village ARCTIC OCEAN 5 Barrow 6 Beaver 7 Bethel 8 Chalkyitsik 9 Eagle 10 Fairbanks 11 Fort Yukon 12Galena .25 13 Hughes 08 14 Huslia '6 15 Juneau *23 TANANA 16 Kodiak PHSU 9a. 17 Kotzebue .24 .10 18 Koyukuk 19 Nome BERING SEA 20 Nulato 21 Ruby 22 St. Paul 23Stevens Village 24 Tanana 25Venetie MT. EDGE C,UMBE .% PHSU 15 *22 PACIFIC OCEAN 1:2:041. ANCHORAGE PHSU ALEUTIAN41) C) Via°191 ,00.0413 is.ts " PHSU =Public Health Service Unit TABLE OF CONTENTS ACKNOWLEDGEMENTS EXECUTIVE SUMMARY 3 CHAPTER I. GENERAL INFORMATION 15 I.A. Background 15 I.B. Organization of this Report 17 CHAPTER II. SOCIAL GEOGRAPHY 18 II.A. Village Alaska 18 II.B. Communications 24 CHAPTER III. HEALTH SITUATION IN ALASKA 29 III.A. General Situation 29 III.B. Hospitalization Trends 30 III.C. Vital Statistics 32 TII.D. High Priority Health Problems 33 III.D. Organization of the Health Delivery System to Native Alaskans 35 CHAPTER IV. BACKGROUND AND PURPOSE OF THE ATS-1 SATELLITE EXPERIMENTS 39 IV.A. Background 39 IV.B. The Operations and their Evaluations 40 CHAPTER V. TECHNICAL EVALUATION OF SATELLITE SYSTEM PERFORMANCE 42 V.A. Background: The ATS-1 Experiment--Communication Before and After Satellite Radio Installation 42 V.B. Methodology 43 V.C. Techniques 44 V.D. Analysis of the Results 45 V.E. Influence of the Location of the Radio Trans- ceiver 46 V.F. Comparison with Villages Where Satellites Were Installed in 1973 ("New Satellite Villages") 47 V.G. One Typical Year of "Doctor Call" 48 CHAPTER VT. EVALUATION OF REMOTE HEALTH AIDE-TO-DOCTOR CONSULTATION VIA SATELLITE 52 VI.A. Health Aide-to-Doctor Communication 52 VI.B, The Health Aides 71 VI.C. Effects on Hospitalization Rates 76 VI.D. Conclusions 86 i TABLE OF CONTENTS, Continued Page CHAPTER VII. EVALUATION OF HEALTH AIDE EDUCATION VIA SATELLITE 88 VII.A. Background 88 VII.B. Methodology 88 VII.C. Results 89 CHAPTER VIII. EVALUATION OF DOCTOR-TO-DOCTOR CONSULTATION BY SATELLITE 91 VIII.A. The St. Paul-Anchorage Link 91 VIII.B. Methodology of Analysis 94 VIII.C. Analysis of the Results 94 VIII.D. Discussion of the Results 106 CHAPTER IX. EVALUATION OF NURSE EDUCATION VIA SATELLITE (by Virginia Hunn Fowkes) 109 IX.A. Needs and Description of the Course 109 IX.B. Evaluation of the Course 115 IX.C. Conclusions and Recommendations 118 CHAPTER X. ASSESSMENT OF SOCIOLOGICAL IMPACT OF RELIABLE TELECOMMUNICATIONS FOR BUSH ALASKA 120 X.A. Communication Between Hospitalized Patient and Family at the Village 120 X.B. Increased Control by the Natives over Communi- cation 121 X.C. Reassurance of the Health Aide and the Patients 121 CHAPTER XI. EVALUATING FUTURE COMMUNICATIONS SYSTEMS (by Dr. Bruce Lusignan and Dr. Michael Sites) 124 XI.A. Selection of Satellite Link 124 XI.B. Selection of Station Configuration 125 XI.C. Simplicity and Performance Test of the Station 126 XI.D. Provisions for More Generalized Telephone Service 127 XI.E. Compatibility with Other Satellite Options and Costs of Modification 127 XI.F. Assessment of the Present Plans of RCA Alascam 129 XI.G. Conclusions 131 ii TABLE OF CONTENTS, Continued CHAPTER XII. RECOMMENDATIONS FOR ACTION AND FUTURE RESEARCH 132 XII.A. Communication Services 132 XII.B. Learning Through Telecommunication 133 XII.C. Community Participation 135 XII.D. Mental Health 136 XII.E. Doctor-to-Doctor Consultation 137 XII.F, Recommendations for Future Research 138 XIT.G. Native Control in Decision-Making 139 XII.H. Considerations for Planning an Expanded Two-Way Communication System 139 ATTACHMENTS T1.1 Telephone in the Villages A-3 11.2 Television in the Villages A-4 II1.1 Comparison of Vital and Health Statistics of Alaska Natives with U. S. A-6 111.2 Ten Leading Notifiable Diseases A-7 111.3 Ten Leading Causes of Hospitalization A-8 111.4 Hospitalization Rate for Native Alaskans Compared With the U. S. Population A-9 IV.1 List of Villages where Satellite Radio Ground Stations were Installed as a Result of the ATS-1 Biomedical Communication Project A-11 V.1 Facsimile of Minitrack Radiolog A-13 V.2 Aide-to-Doctor Contacts via ATS-1 A-14 VI.1 Examples of Emergency Evacuation Cases A-16 VI.2 Example of Log Kept by the Doctors at Tanana HospitalA-21 VI.3 Codes for Description of Consultation A-22 VI.4 Demographic Data of the Villages Considered A-23 VI.5 Hospitalization rates for ANMC A-26 VI.6 Hospitalization rates for Tanana Hospital A-27 VI.7 Hospitalization rates for Both Hospitals A-28 VI.8 Codes of Diseases A-29 VI.9 Sample "Doctor Call" Transcript A-31 VIII.1 St. Paul Doctor's Questionnaire A-37 VIII.2 Consultants' Questionnaire A-41 VIII.3 List of Diagnoses of the Consulted Cases A-45 IX.1 Description of the Course A-47 IX.2 CCU Course Objectives A-49 IX.3 CCU Course Schedule A-50 IX.4 CCU Test and Standards A-51 IX.5 Tabulation of Student Responses A-53 iii TABLE OF CONTENTS, Continued Pap? ATTACHMENTS, Continued XI.1 Comparison of Anik and Intelsat Satellites A-59 XI.2 The Satellite System Design Program: A Method of Satellite Communications System Optimization A-66 XI.3 Alaska Public Health Service Units Community Profile A-123 XI.4 Parameters and Costs of the Least-Cost Satellite System Configuration A-154 XI.5 The Point Reyes Station Tests A-168 XI.6 Specifications for a Small Satellite Communications Earth Station A-221 XI.7 Central Manual Telephone Exchange A-244 XI.8Alaskan Indian Health Service Satellite Communica- tion Station A-247 XI.9 Alaska's Communications Needs and Potential Solu- tions Utilizing Satellites A-253 XI.10Review of RCA Small Station Request for Proposal A-265 iv -1- ACKNOWLEDGEMENTS Results of many efforts have been synthesized in this report. Previous analyses are mentioned in the references. Data presented in them have been used, and in some cases re-analyzed, for this report. The work of the principal investigators, Dr. William Fowkes and Professors Bruce Lusignan and Edwin B. Parker, has been central to this study, both in the organization of the evaluation and in the analysis and discussion of the findings. Dr. Heather Hudson, Dr. Michael Sites, and Dennis Foote have also played principal roles, the latter especially in the preparation of the data collection forms and their codification. Previous work by them and by Dr. Maureen Sass, Marc Porat, Carl Mitchell, Angel Velasquez, Simon Chu, and Dr. Brian Beattie made possible some of the findings and descriptions presented here. Dr. Glenn Stanley and his team at the Geophysical Institute, University of Alaska, College, gave support facilities and personal help in conducting the field research. Theodore Vieira, Director of the Office of Systems Development at the Alaska Area Native Health Service (AANHS) provided access to a great deal of data. The doctors at the facilities in Tanana, Anchorage, and the Pribilof Islands gave generously of their time and knowledge. Valuable comments were received from different people at Alaska, Stanford, and Washington, D. C., and this final version has been highly enriched by their suggestions.

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