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

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.