178695 Pneumonia and influenza outcomes in elderly with dementia: The effect of proximity to healthcare facilities

Tuesday, October 28, 2008

Manisha Pandita , Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA
Sara M. Parisi, MS/MPH , Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA
Denise Castronovo, MS , Mapping Sustainability, LLC, Jupiter, FL
Elena Naumova, PhD , Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA
Inadequate or inaccessible health care services increase the vulnerability of elderly patients and elevate the risk of complications associated with viral infections. Elderly with dementia can be at high risk for influenza induced pneumonia, due to communication difficulties that may prevent timely diagnoses. We used geographic mapping technology to investigate the effect of geographic proximity from place of residence to healthcare facilities on P&I outcomes in elderly with dementia. We abstracted 43,812 hospitalization records with an indication of P&I (ICD 9 codes: 480-487) and dementia (ICD 9 codes: 290-294, 331, 797) from the Centers for Medicare and Medicaid Services (CMS) database between 1998-2002 for New England (NE) residents and estimated the mean length of hospital stay by county of the residence. We also abstracted geographic positioning data for Medicare and Medicaid-certified nursing homes. We quantified absolute and average proximity to health care facilities by measuring geo-spatial distance between nursing homes and neighboring hospitals using ESRI's ArcGIS software. Our preliminary results indicate that in Massachusetts, the average distance varied with regards to county rurality. Rural Berkshire and Franklin counties have the highest mileage to neighboring hospitals (10.5-20.7 miles), whereas urban Suffolk County has the lowest average mileage (0.7-2.3 miles). Overall, the mean length of stay was greater for rural counties (ranging from 7.0-8.65 days) than for urban counties (6.1-6.74 days), suggesting rural elderly may have experienced delayed access to health care. Urban versus rural proximity by county and zip code will be further explored throughout the New England region.

Learning Objectives:
1.Recognize that proximity to healthcare facilities differs by state and county level. 2.Articulate how rural vs. urban status may potentially affect pneumonia and influenza outcomes in the elderly with dementia. 3.Discuss the strengths and limitations of using geographic information systems in public health research.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the PI on an NIH funded study on influenza in the elderly.
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.