QIOs in Action: Promoting Antimicrobial Stewardship in Rural Alaska

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Alaska is the largest state in the nation — more than twice the size of Texas. Despite its size, it is one of the least populated states in the nation with fewer than 750,000 residents and the lowest population density at approximately 1.2 people per square mile, according to the United States Census Bureau.

Further, the vast majority of the state is completely uninhabited. More than 400,000 of Alaska’s residents live in the Anchorage, Alaska metropolitan region according to the Alaska’s Department of Labor and Workforce Development. The remaining population is spread across hundreds of villages and towns in remote regions of the state.

The vast and sparsely connected nature of the state presents significant challenges in providing quality health care services to Alaskan citizens. Only 14 percent of state municipalities are connected to a road system, and many rural communities lack basic resources like indoor plumbing. They also lack access to health care professionals. These circumstances have resulted in higher rates of infectious diseases compared to other states in the U.S., according to a 2013 study from the National Institutes of Health [NIH].

Alaska’s native people are divided into 11 distinct cultures, speaking 11 different languages and 22 different dialects. There are more than 228 federally recognized tribes in Alaska, according to the Indian Health Service (IHS), which contributes to the challenges of providing health information and education to Alaska’s rural and remote populations.

"In Alaska, partnerships are critcal to helping ensure the health of people in remote areas." 

Given the challenges of geography, infrastructure and high rates of infection, Mountain – Pacific Quality Health—the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Alaska, Hawaii, Montana, Wyoming and the U.S. Pacific Territories of Guam, American Samoa and the Commonwealth of the Northern Mariana Islands — recognized the need to partner with the Indian Health Service (IHS) to promote antimicrobial stewardship best practices among residents and providers.

Together, Mountain – Pacific and IHS determined that a partnership to intervene on antimicrobial stewardship would be symbiotic for both networks. IHS would use its expansive network, which is knowledgeable about the various regions and cultures throughout Alaska — to distribute resources made possible by Mountain – Pacific.

Stepping back and looking at our goal strategically, we knew we needed to partner with IHS if we were going to meet our goal to expand care,” said Lori Chikoyak, nurse project manager at Mountain – Pacific. "In Alaska, partnerships are critcal to helping ensure the health of people in remote areas." 


By collaborating with IHS health centers, Mountain – Pacific recruited 216 care settings in Alaska to provide antimicrobial stewardship education and resources to residents across the state. With an initial recruitment goal of 140 sites, Mountain – Pacific successfully recruited 154 percent of its initial target goal.

Mountain – Pacific is also in the process of creating closed-circuit television ads and promotional videos in six different languages to broadcast to Alaska residents in an effort to reach the various native languages present across the large state. Additionally, numerous IHS facilities are working to adapt Mountain – Pacific’s health aid manual to regional tribes’ native languages in order to provide an understandable reference guide to communities.