245503 Local safety net clinics and chronic obstructive pulmonary disease (COPD) hospitalization

Tuesday, November 1, 2011

Bradford Jackson, MPH , Department of Biostatistics, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX
Fenghsiu Su, MSBA , Department of Biostatistics, University of North Texas Health Science Center, School of Public Health, Fort Worth, TX
Sumihiro Suzuki, PhD , Department of Biostatistics, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX
Ravi Lingineni , Department of Biostatistics, University of North Texas Health Science Center, School of Public Health, Fort Worth, TX
Kaming Lo, MPH , Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL
Alfred Bartolucci, PhD , Department of Biostatistics, University of Alabama Birmingham School of Public Health, Birmingham, AL
Karan P. Singh, PhD , Department of Biostatistics, University of North Texas Health Science Center, School of Public Health, Fort Worth, TX
David Coultas, MD , Department of Medicine, University of Texas Health Science Center at Tyler, Tyler, TX
Sejong Bae, PhD , Department of Biostatistics, School of Public Health, UNT Health Science Center School of Public Health, Forth Worth, TX
Background: Geographic variation in hospitalization rates for chronic obstructive pulmonary disease (COPD) exist. Patient access to care may contribute to variation in hospitalization rates. The objectives of this study were to examine differences in COPD hospitalization rates by (1) presence of federally qualified health centers (FQHC) and rural health clinics (RHC) in Texas counties and (2) number of pulmonary specialists in a county. Methods: This study utilized data from the 2007 Texas Health Care Information Council (THCIC), Texas demographer population projections, and the 2009 Area Resource File (ARF). The unit of analysis was county specific rate, which was calculated as discharges of county residents divided by the county level population. Counties were divided into four mutually exclusive categories based on presence of FQHCs and RHCs. Poisson regression was used to model the relationship between hospitalization rates, county types, and number of pulmonary specialists adjusting for aggregated county level covariates. Results: The COPD related hospitalization rates (per 10,000 observations) by safety net types in ascending order were: FQHC only (9.267), Both FQHC and RHC (12.63), Neither FQHC nor RHC (13.75), and RHC only (17.42). In counties with only RHCs the increase of one pulmonary specialist, resulted in an 8.5% decrease in the hospitalization rate. Rates differed significantly according to FQHC and RHC presence. Conclusions: The counties with a FQHC were associated with lower COPD hospitalization rates in Texas. The higher rates of hospitalization in counties with RHCs suggest inadequate access to care. Improving access to health centers in rural areas may reduce avoidable hospitalizations in Texas.

Learning Areas:
Chronic disease management and prevention

Learning Objectives:
Evaluate safety net facilities as a risk factor for COPD. Compare adjusted prevalence ratio by presence of safety net facilities in COPD subjects.

Keywords: Community Health Centers, Chronic Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract Author on the content I am responsible for because: I assisted with the conceptualization and performed the analysis.
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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