Difference in Association Between State-Level Health Outcomes for Direct Patient Care FTEs and Population Based FTEs

This presentation will examine the association between state level health outcomes and direct patient care FTEs and the association between state level health outcomes and population based FTEs. Direct patient care FTEs included physicians, public health nurses, and nutritionist. Population based FTEs included environmental health workers, epidemiologists/statisticians, health educators, public health information specialist, and laboratory workers. This was a cross sectional student using Association of State and Territorial Health Officials Profile 2010, Americans Health Rankings 2010 edition, Census 2010, and Area Resource File data. Descriptive, bivariate, and multivariate analyses were conducted. All data sets were merged at the state level. Bivariate analyses were used relating state level health outcomes to population based FTEs per population 100,000, direct patient care FTEs per population 100,000, and potential confounders {governance, demographic characteristics, socioeconomic status, enforcement powers, presence of board of health, expenditures, etc]. Multiple imputation was used in order to account for states with missing data in FTEs. Multivariate analyses were conducted while entering in simultaneously population based FTEs and direct patient care FTEs potential confounders meeting criteria of p value less than 0.20 were entered in stepwise. Assessment of whether the adjusted association between population based FTEs and state level health outcomes differed from association beteen direct patient FTEs and state level health outcomes was performed using linear contrast. Results to date show that the is a signficant difference in the association between population based FTEs and direct patient care FTEs for certain health outcomes including prevalence of diabetes. Limitations and future directions for the research will be highlighted. This study is among the first to look at provider type and health outcomes at the state level for public health workers.