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182654 Methodology to estimate influence of contextual (county) and individual correlates on primary quality indicators (PQI) & inpatient quality indicators (IQI), among persons 65+, in the 32 Texas border counties

Tuesday, October 28, 2008

Frank C. Lemus, PhD , Jeane B. Kempner Scholar, Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
Alai Tan, MD, PhD , Senior Biostatistician, Office of Biostatistics, The University of Texas Medical Branch, Galveston, TX
Daniel H. Freeman, PhD , Director, Office of Biostatistics, The University of Texas Medical Branch, Galveston, TX
Jean L. Freeman, PhD , Departments of Internal Medicine (Geriatrics) and Preventive Medicine and Community Health (Epidemiology and Biostatistics), The University of Texas Medical Branch, Galveston, TX
Objective: Contextual factors may influence individual health in a community. Mechanisms linking neighborhood advantage/disadvantage to better/poorer health outcomes are complex. This may be related to community variations in quality of care. We provide methodology to understand how community contextual factors affect PQI and IQI for pneumonia, persons 65+, 32 Texas border counties.

Methods: New Texas hospital discharge data provides basis to estimate PQI & IQI pneumonia rates. Contextual factors include: for PQI: race/ethnic homogeneity, poverty, sex; for IQI: teaching hospital, race/ethnic homogeneity & severity of illness. We estimated NHW, Black, and Latino baseline hospitalization (PQI) & mortality (IQI) rates derived from public use files of Texas Health Care Information Council's hospital discharge abstracts (1999-2001). Population counts & community characteristics derived from 2000 U.S. Census. Exact AHRQ identified ICD-9-CM pneumonia codes to extract PQI & IQI data. Design: Healthy People 2010 methodology used to calculate hospitalization & mortality rates. Numerator: number of pneumonia hospital discharges, 65+, in County multiplied by 10,000. Denominator from Census: number of persons 65+ in County multiplied by 3. 2000 U.S. Census was mid-point in rate determination. Implications: Methodology informs stakeholders to: assess population health status (funding, immunization, treatment priorities); identify pneumonia disparity rates among NHW, Blacks,Latinos; utilize baseline rates for future comparability studies with Texas counties, 4 U.S. and 6 Mexico border states; use of hospital discharge data for community based health services research; understand neighborhood influences on population health; extend analysis to other AHRQ, Healthy Border & Healthy People 2010 quality of care indicators.

Learning Objectives:
1. Describe one Agency on Healthcare Research and Quality (AHRQ) Prevention Quality Indicator (PQI). 2. List three contextual (county)characteristics used in study. 3. Describe Healthy People 2010 methodology for hospitalization rate calculation. 4. Describe and define the United States-Mexico Border Region. 5. Articulate use of hospital discharge data for community based health services research.

Keywords: Outcomes Research, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted the research following University and AHRQ guidelines, protocols and requirements.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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