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Pathways to Health:

Policy, Practices

and Partners

The 84th Annual

Conference

Presented by the San Antonio Metropolitan Health District and Texas Public Health Association

The Radisson Hill Country Resort & Spa

March 5-7, 2008

San Antonio, Texas

Pathways to Health: Policy, Practices and Partners

WELCOME FROM THE PRESIDENT

I am very pleased to welcome you to the Texas Public Health Association 84th Annual Educational Conference.  This year, we have developed the program for those of you in the “grass roots” areas by looking at federal, state and local policies which serve as the guide for all public health partners.  We have excellent speakers who will update you on these policies and suggest practices which might be helpful to you as professionals in all areas of the state of Texas.  You will notice our proposed vision and mission of the association posted in various areas.  We want your feedback about these proposals to any executive board or governing council member. This association is for you and because it is for you, we would like to encourage you to share in the revision of the strategic plan by giving us your comments on the proposed vision and mission.  Again, welcome!  As an association, we are excited about our program, excited to see you here, and look forward to a good experience.

CONTINUING EDUCATION (Pick up your CEU paperwork at registration desk)

Physicians-CME: Texas Department of State Health Services is accredited by the Texas Medical Association to provide continuing medical education for physicians. TDSHS designates this educational event for a maximum of 14.00 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit he/she actually spent in the educational event.

Nurses-CNE: The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 14.00 continuing nursing education contact hours has been awarded by the DSHS CE service. Each nurse should claim only those hours of credit that he/she actually spent in the educational event.

Health Educators-CHES: Application for Category I continuing education contact hours for CHES has been made to the Texas Department of State Health Services, CE Service which has been designated as a provider of continuing education contact hours by the National Commission for Health Education Credentialing, Inc. The TDSHS CE Service has awarded a maximum of 14.00 contact hours.

Social Workers-SW: The Texas Department of State Health Services, under sponsor number CS3065, has been approved by the Texas State Board of Social Work Examiners to offer continuing education units to social workers. The CE Service has awarded a maximum of 14.00 continuing education credits.

Registered Sanitarians-RS: Certificate of Registered Sanitarians: The Texas Department of State Health Services is considered a sponsor of Registered Sanitarians according to the Texas Administrative Code, Title 25, Part 1, Chapter 265, Subchapter K, Rule §265.147. The PHW CE Service has awarded a maximum of 14.00 hours.

Certificate of Attendance: This activity was awarded 14.00 contact hours.

EXHIBITORS-Commercial and educational exhibitors will be located in the Rotunda of the hotel.

Exhibits will be set up from Wednesday, March 5th 12:00 noon until Thursday, March 6th 6:30 p.m. Special events such as the grand opening “Wine and Cheese” and the President’s Reception will be held in the Exhibit area. Please visit the exhibits during these events!

PUBLIC HEALTH PRESENTATIONS-Abstracts on Public Health Education Materials (Projects designed to educate the public on a public health topic) Research Papers: (Original research of an empirical nature, conceptual or methodological issues or innovative techniques in a public health area) and Poster Presentations: (Original research of an empirical nature, conceptual or methodological issues or innovative techniques in a public health area) will be presented and/or displayed.

EVALUATIONS-Your feedback helps us to make each subsequent conference a meaningful, educational and fun experience for you. Please complete the evaluation and submit it prior to your departure.

PRESIDENT’S RECEPTION- The Reception will be held Thursday, March 6th from 4:45-6:15 p.m. The following awards and recognition will be presented during the President’s Reception: Recognition of Officers, Governing Council and Committees, New Fellow Recognition, Exhibitor Recognition, Media Awards, Recognition of Immediate Past President, Outstanding Service Award, President’s Award, Jessie A Yoas Memorial Award, Thinking Progressively for Health (TPHA) Award, Honorary Life Member Award and James E. Peavy Memorial Award.

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8:30 am-4:30 pm Conference Registration HOTEL LOBBY

8:30 -11:30 am Pre-Conference Workshop OFF SITE

Evidence-Based Public Health Practice: Using Research and Data to Improve Your Programs, Helena M. Von Ville, Library Director, University of Texas School of Public Health, Houston, TX

9:30 – 11:30 am Pre-Conference Workshop AGARITA

Making the Connection between Housing and Health

Sponsored by the Texas Public Health Training Center

Speakers: Nancy M. Crider, MS, RN, University of Texas School of Public Health, Houston and Brenda Reyes, MD, MPH, City of Houston Health and Human Services, Childhood Environmental Health

This training activity will discuss the increasing scientific evidence that links housing conditions to health and identify the root causes of housing related health problems such as asthma & allergies, lead poisoning, cancer and common preventable injuries. A holistic approach to identifying and resolving housing problems that are harmful to the health and well-being of children and families will be discussed. The “Seven Principles of Healthy Housing”, based on the National Center for Healthy Housing (NCHH), Essentials for Healthy Homes Practitioner Course, will be introduced.

1 – 3 pm Opening Assembly WESTOVER ASSEMBLY AUDITORIUM

1 – 1:45 pm Welcome by TPHA President Sandra Strickland, RN, DrPH, Mayor &

Fernando A. Guerra, MD, MPH, FAAP, Director, San Antonio Metropolitan Health District

1:45 – 2:45 pm Keynote Address- Forging an Enduring Partnership Between Public Health Academics and Practice in Texas, David L. Lakey, MD, Commissioner of Health, Texas Department of State Health Services, Austin

2:45 - 3 pm 2008 Texas Cardiovascular Health Promotion Awards Presentations by the Texas Council on CVD and Stroke

3-3:15 pm Stretch break

3:15 – 4:45 pm Public Health Presentations WESTOVER ASSEMBLY AUDITORIUM

Moderator, Patricia Diana Brooks, MEd, MS

Intentional Poisoning Exposures Reported to the Texas Poison Control Center, Marcia Becker, MPH, Texas Department of State Health Services

Inpatient Admissions for Infection in Cancer Patients: Impact of an Aging Population, Catherine Cooksley, DrPH, University of Texas M. D. Anderson Cancer Center

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Public Health Presentations (Continued) WESTOVER ASSEMBLY AUDITORIUM

Following the Roadmap to Preparedness Data: Creating a Public Health Preparedness Dashboard, Catherine Pepper, MLIS, MPH, Centers for Disease Control & Prevention

Assessment of Evidence-based Prevention Practices within a Residency Based Family Practice Center, Linda Hook, RN, MSN, Bexar County Hospital District dba University Health System

Hispanic Ethnicity & Foreign Nativity as Predictive Factors of Community Health Center Utilization as a Regular Source of Care, Erin K. Carlson, MPH

Graduate Research Assistant, University of North Texas Health Science Center

School of Public Health, Department of Health Management and Policy

4:45 – 6:00 pm Opening of Exhibits & Posters (Wine & Cheese) SUNSPOT/FOYER AREA

6:45 – 7:30 pm TPHA Governing Council Meeting AGARITA [pic]

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6:30 – 7:30am Health Walk (meet in hotel lobby) HOTEL LOBBY

7 am-4 pm Registration HOTEL LOBBY

8 – 9 am GENERAL SESSION WESTOVER ASSEMBLY AUDITORIUM

Health Policy Case Study on Tobacco

Steven R. Shelton, MBA, PA-C, Moderator, Assistant Vice President, Division of Community Outreach, UTMB; Executive Director, East Texas AHEC.

He will present the case study on tobacco and will discuss health policy changes from the clinical perspective, and changes in health measures and outcomes.

William M. Sage, MD, JD, University of Texas, School of Law, Vice Provost, Health Affairs, James R. Dougherty Chair for Faculty Excellence in Law. To discuss a few historical aspects of tobacco, agents of change, cite a few landmark policy changes, and identify medical/social ‘tipping points’ that influenced those changes.

Roger D. Barker, MBA, RS, Director/Administrator, City of Waco-McLennan County Public Health District. To discuss how policy changes affected PHD mgmt & staff activities, operations, services, programming, enforcement, etc., and how PHD staff implemented policy changes at the community / public health level.

9:15 – 10:15 am GENERAL SESSION WESTOVER ASSEMBLY AUDITORIUM

Presidential Politics, Taxes and Wellness (Panel Discussion)

Eduardo Sanchez, MD, MPH, Moderator, Professor, and Director, Institute for Health Policy, School of Public Health, University of Texas Health Science Center at Houston

Paul B. Handel, MD, Chief Medical Officer, Health Care Service Corporation

William M. Sage, MD, JD, University of Texas, School of Law, Vice Provost, Health Affairs, James R. Dougherty Chair for Faculty Excellence in Law.

The burden of chronic disease is growing. 75% of medical care costs are attributable to chronic disease care. The medical model of care in the doctor’s office is but one piece of that process. Healthcare costs and health insurance are other pieces. The wellness model of individual-and community-based health literacy and education, prevention and self- management is a vital component. Is the current healthcare system well designed to deal with these issues? Are the presidential candidates talking about these issues? Are they thinking about anything other than insurance packages and benefits designs? Have any of them considered the overall scheme, the big picture regarding health policy? What are their positions on health and the national mission for healthcare? This session will present a comparison of the presidential candidates’ positions on health/ wellness, and the implications for health policy. The panelists will also discuss the concept of wellness at the state and national level, as a continuation of last year’s session on Unhealthy Behaviors and Chronic Diseases, a True Threat to the Health of Texans

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10:15 – 10:45 am Break WESTOVER ASSEMBLY AUDITORIUM

10:45 – 11:45 am GENERAL SESSION WESTOVER ASSEMBLY AUDITORIUM

Texas Mental Health Transformation Initiative

Sam Shore, Texas Department of State Health Services and Camille D. Miller, MSSW, President/CEO, Texas Health Institute

11:45 -12:45 pm Lunch on your own

Past Presidents’ Lunch (meet in hotel restaurant)

Public Health Nursing Luncheon WESTOVER ASSEMBLY AUDITORIUM

Workforce Issues, Kathi Light, EdD, MSN, RN, Professor and Dean, University of the Incarnate Word (Pre-registration required)

1 – 3 pm CONCURRENT SESSIONS

Chronic Disease MEDIA ROOM

Facilitator-Jennifer Smith, MSHP

Using What Works: Adapting Evidence-Based Programs to Fit Your Needs, Ginny Thompson, MPH, CHES, National Cancer Institute’s Cancer Information Service, MD Anderson Cancer Center.

Implementing Evidence-Based Programs in the Prevention & Control of Arthritis, Jeff Savage, BS, Director of Programs, Arthritis Foundation, Texas Chapter

The presentation will present information on the latest research to reduce pain and increase mobility for persons with arthritis and the current evidence-based programs developed that use physical activity and self-management as means to achieve those results that can be implemented in the community setting.

Objectives: Name evidence-based practices for major chronic disease conditions, and; Name one evidence-based practice that the participant will commit to introduce into their community or work program practices.

Environmental & Consumer Health NANDINA

Facilitator-Janice Hartman, RS

Food Imports Along the Texas-Mexico Border & DSHS Manufactured Foods Inspections, Seri Essary, BS, RS, Manager, Foods Inspection South, Division for Regulatory Services, Texas Department of State Health Services, Austin

Zoonotic Diseases in Texas (Dengue and Scrapie), Catherine Tull, DVM, Region 8, Texas Department of State Health Services, San Antonio

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Epidemiology AGARITA

Moderator, Patricia Diana Brooks, MEd, MS

2007: Disasters in Review

Scott R. Lillibridge, MD, Texas A & M Health Science Center, School of Rural Public Health and Dennis M. Perrotta, PhD CIC, Texas A&M School of Rural Public Health, Houston, Texas, and Mary des Vignes-Kendrick, MD, MPH, Texas A & M School of Rural Public Health

The top 5 disasters of 2007 will be reviewed.  The panel will discuss key public health system elements of these disasters such as communication, information sharing, collaboration, response effectiveness and crisis leadership. The perspectives of these three distinguished public health practitioners, whose practice span the federal, state and local levels, will serve as the starting point for a facilitated and interactive discussion with audience participants.  How did public health fare in preparing and responding to these disasters in 2007?  This session will consider the critical public health preparedness competencies and how they were depicted in deciding the outcome of these disasters.

What do Epidemiologists Do?  Competencies for Applied Public Health Epidemiology Practice, Dennis M. Perrotta, PhD CIC, Texas A&M School of Rural Public Health, Houston, Texas

In order to improve the practice of epidemiology among public health agencies, a comprehensive list of competencies was created that defines the discipline of applied epidemiology and describes what skills four different levels of practicing epidemiologists working in government public health agencies should have to accomplish required tasks.  The process and the competencies will be reviewed.

Health Policy LANTANA

Facilitator-Douglas H. Fabio, MHA

Putting the “Force” Into the Public Health Workforce

Part A-Changes and Challenges in the Public Health Workforce,

Rick Danko, DrPH, Texas Department of State Health Services

Objective: Describe the composition of the Texas public health workforce, including gaps between needed and existing competencies.

Part B-Making Public Health an Exciting and Lasting Profession

Joan Hutton, BA, RN, CPC, The Hutton Group, Inc., Vero Beach, FL

Objective: Relate how your organization can adapt creative strategies to recruit and retain critically needed professionals.

Part C-Assuring the Next Generation of Leaders

Joan Hutton, BA, RN, CPC, The Hutton Group, Inc., Vero Beach, FL

Objective: Explain how to identify and energize future public health leaders through succession planning.

Reactor Panel for Parts A-C above followed by questions and answers

Moderator: Douglas H. Fabio, MHA

Panelists: Larry Johnson, MS, MBA, Abilene-Taylor County Public Health District, Stephen Williams, MEd, MPA, City of Houston Department of Health and Human Services, Rick Danko, DrPH, Texas Department of State Health Services

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Public Health Nursing WESTOVER ASSEMBLY AUDITORIUM

Facilitator- Alexandra Garcia, PhD, RN

Best Practices in Health Promotion Programs for Kids

Lead Safe in San Antonio, Linda Kaufman, MSN, RN, CS, Environmental Health Nursing Program Manager, San Antonio Childhood Lead Poisoning Prevention Program, San Antonio Metropolitan Health District AND Myrna Esquivel, MS, Construction Specialist Supervisor, Lead-Based Paint Hazard Control Program, Neighborhood Services Department

School Health Practice: Treatment versus Prevention, A Cry for Help, Susan Franzetti, MSN, RN, Pflugerville Independent School District, Student Health Coordinator, After the presentation, participants will be able to describe the practice of school health in Texas, list 5 state-mandated areas of school health requirements and contrast differences between the traditional medical model of school health and the integration of public health concepts into school health practice.

A Statewide QA Children’s Immunization Program, Sandra Benavides-Vaello, BSN, MPAff, PhD(c), Director of Clinical Affairs, Texas Association of Community Health Centers This session addresses quality assurance in immunization programs.

3 - 3:15 pm Break and Visit Exhibits and Posters SUNSPOT/FOYER

Chronic Disease MEDIA ROOM

Facilitator-Jennifer Smith, MSHP

Pediatric Asthma: Bridging the Gap Between Acute and Chronic Care,

Charles G. Macias, MD, MPH, Associate Professor of Pediatrics, Director, Pediatric, Emergency Medicine Fellowship, Research Director, Section of Emergency Medicine, Baylor College of Medicine, This session will explore the gaps in the health care system that serve as barriers to improving the public health for children with asthma. Solutions through system changes will be addressed and best practices described to define ways to improve care for families with asthmatics while decreasing health care resource utilization.

Reducing High Blood Pressure in the Hispanic Population through Clinical and Worksite Programs, Eva Dunn and Lourdes Rangel, Gateway Community Health Center

Pediatric Asthma: Bridging the Gap Between Acute and Chronic Care,

Charles G. Macias, MD, MPH, Associate Professor of Pediatrics, Director, Pediatric, Emergency Medicine Fellowship, Research Director, Section of Emergency Medicine, Baylor College of Medicine, This session will explore the gaps in the health care system that serve as barriers to improving the public health for children with asthma. Solutions through system changes will be addressed and best practices described to define ways to improve care for families with asthmatics while decreasing health care resource utilization.

Reducing High Blood Pressure in the Hispanic Population through Clinical and Worksite Programs, Eva Dunn and Lourdes Rangel, Gateway Community Health Center

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3:15 – 4:45 pm Concurrent Sessions continued

Environmental & Consumer Health NANDINA

Facilitator-Janice Hartman, RS

Public Health Considerations of Methicillin-Resistant Staphylococcus Aureus (MRSA), Bryan J. Alsip, MD, MPH, FACPM, San Antonio Metropolitan Health District

Environmental and Consumer Health Section Meeting-Janice Hartman, RS

Epidemiology AGARITA

Moderator, Patricia Diana Brooks, MEd, MS

Climbing the Money Tree: Locating Grants and Funding, Michelle Malizia, MA National Library of Medicine at HAM/TMC Library

Health Policy LANTANA

Facilitator- Hardy Loe, Jr., MD, MPH

Workforce Implications of National Voluntary Accreditation of State and Local Health Departments; Current State of Implementation of the National Accreditation Program

Hardy Loe, Jr., MD, MPH.  Dr. Loe will outline the original work of the Exploring Accreditation Steering Committee, which established recommendations for the Voluntary Accreditation Program leading to the incorporation of the Public Health Accreditation Board in May 2007 and the hiring of Dr. Albert Gray as Executive Director. 

Richard S. Kurz, PhD, Professor and Dean, University of North Texas Health Science Center School of Public Health.   As a representative of a public health academic institution in Texas, Dr. Kurz will be in a position to discuss the teaching, research and technical assistance roles to be played in the new program.  In addition, Dr. Kurz brings important experience from his role as Co-Chair of the Accreditation Council for Local Health Departments in Missouri, the Missouri Institute of Community Health.  The state of Missouri began exploring accreditation in the 1990's and formalized its program in the Missouri Institute for Community Health in 2002. 

 

Isaac Joyner, MPH, Bureau Chief for Health Planning, Houston Department of Health and Human Services.  As an experienced public health practitioner in a major health department in the state, Mr. Joyner will be able to identify and discuss the meaning and significance of accreditation in a metropolitan setting. 

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Health Policy continued LANTANA

Facilitator- Hardy Loe, Jr., MD, MPH

Hector Gonzalez, MD, MPH, Director of the City of Laredo Department of Public Health.  Dr. Gonzalez is in charge of a middle size health department and will speak to how accreditation in a department of that size affects these same issues.  Because of its location on the border of Mexico, the City of Laredo interacts routinely with international public health, so that these issues will also be of interest to the audience.

Fernando A. Guerra, MD, MPH, Director of the San Antonio Metropolitan Health District.  In addition to directing a large metropolitan health department in the state, Dr. Guerra brings two other perspectives that will be of interest to the audience.  He is a member of the Accreditation Planning Committee of the National Association of County and City Health Officials (NACCHO), and he is also a member of the National Public Health Accreditation Board, which is responsible for governing the new national accreditation program. 

In addition, the San Antonio Metropolitan Health District has been asked by NACCHO to conduct a self-assessment as part of their accreditation planning efforts. 

Mike Czepiel, BBA, Senior Public Health Liaison, Regional and Local Health Services Division, Texas Department of State Health Services (TDSHS).   Mr. Czepiel, among other duties, serves as the focus for development of the State Agency's role in voluntary accreditation, with respect to the TDSHS role in providing local health services in cities and counties that do not have local public health departments as well as the Department's responsibilities to interact with local health departments throughout the state.

Bing Burton, PhD, Director, Denton County Health Department and Member of the Accreditation Committee of the Texas Association of Local Health Officials (TALHO).  TALHO is developing an initiative to assist Texas in the implementation of Voluntary Accreditation.  Toward that end the TALHO Board of Directors has invited representatives of the Missouri Community Health Institute to their retreat at the end of February as they work this out.  Dr.  Burton will report on this initiative to the audience.   

Public Health Nursing WESTOVER ASSEMBLY AUDITORIUM

Facilitator-Alexandra Garcia, PhD, RN

Best Practices in Health Promotion Programs for Adults

Your Health is in Your Hands: Developing a Topical Health Literacy / Education Campaign, Deborah Flaniken, East Texas Area Health Education Center, Session participants will review/discuss the elements of an effective topical health education campaign, using a pandemic flu model. Participants will use the model to collaboratively draft a pediatric obesity campaign.

Advances in Contraception, Janet Realini, MD, MPH, San Antonio Metropolitan Health District

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4:45 – 6:15 pm President’s Reception & Awards Presentations SUNSPOT/FOYER

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6:30 – 7:15am Health Walk (Meet in Hotel Lobby) HOTEL LOBBY

8 am-1 pm Registration HOTEL LOBBY

8:30 – 9 am Breakfast WESTOVER ASSEMBLY AUDITORIUM

9 – 11 am Closing General Session WESTOVER ASSEMBLY AUDITORIUM

Alzheimer’s Disease Consortium Panel Discussion

Bobby Schmidt, MEd, RS, Moderator

Treatment in Alzheimer’s Disease, Rachelle Smith Doody, MD, PhD, Baylor College of Medicine, Houston

Neurodegenerative Disease: New Research and Therapy Strategies, Roger Rosenberg, MD, UT Southwestern Medical Center, Dallas

The Wisdom of Aging, Randolph Schiffer, MD, Texas Tech University, School of Medicine, Lubbock

Options for Care for Dementia Patients, Janice Knebl, DO, MBA, Dallas Southwest Osteopathic Physicians Endowed Chair in Clinical Geriatrics at the University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth

Texas Alzheimer’s Research Consortium Update, Stephen C. Waring, DVM, PhD, University of Texas Health Science Center, Lead Scientist for the Texas Alzheimer’s Research consortium

The session will offer the latest information on Alzheimer’s disease research, the diagnosis and treatment of Alzheimer’s disease, and innovations in care to improve the quality of life for individuals with Alzheimer’s disease and related disorders, their family members, and caregivers. The session will be presented by world-renowned authorities in Alzheimer’s research, treatment and care.

11 – 11:30 am Closing Remarks, Transfer of the Gavel and Incoming Presidents Remarks by Linda Hook, RN, MSN, (incoming President)

Public Health Presentations Awards-Patricia Diana Brooks, MEd, MS

11:30-12:30 pm 2009 Annual Education Conference Program Planning LANTANA

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The Texas Public Health Association extends its gratitude

to the following for their excellent work in contributing to the overall success of the

84th Annual Education Conference

Sandra Strickland, RN, DrPH, Chair and TPHA President

Fernando A. Guerra, MD, MPH, Host

San Antonio Metropolitan Health District Staff

Adriana Babiak-Vazquez, MPH, Second Vice-President

Patricia Diana Brooks, MEd, MS, First Vice-President

Julio Allo, MPH, Epidemiology

Catherine Cooksley, DrPH, Website

Nancy Crider, Pre-conference

Mary desVignes-Kendrick, M.D, M.P.H, Epidemiology

Debra Edwards, MS, RNC, ONC, Continuing Education

Doug Fabio, MHA, Health Policy

Deborah Flaniken, General Session

Alexandra Garcia, PhD, RN, Public Health Nursing

Karla Gutierrez, MPH, Epidemiology

C. Lee Hamilton, Health Policy

Janice Hartman, RS, Environmental

Linda Hook, RN, BSN, MSHP, President-Elect

Linda Kaufman, MSN, RN, CS, Public Health Nursing

Hardy Loe, Jr., MD, Health Policy/General Session

Amy Pearson, Continuing Education

Eduardo Sanchez, MD, MPH, General Session

Bobby Schmidt, General Session

Dan Smith, MEd, CHES, Continuing Education

Jennifer Smith, MSHP, Immediate Past President, Chronic Disease

Cathy Troisi, PhD, Health Policy

Helena VonVille, Pre-conference

Special thanks to:

Silent Auction Contributors

Sponsors:

University of Texas School of Public Health

for sponsoring the Public Health Presentations

Organon, a part of Schering-Plough

Advertisers:

University of Texas School of Public Health

School of Public Health at the University of North Texas Health Science Center

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Presenters and Moderators

Bryan Alsip, MD, MPH, FACPM

San Antonio Metropolitan Health District

332 West Commerce

San Antonio, Texas 78205

210- 207-8172

bryan.alsip@

Roger D. Barker, MBA (HCA), RS

Waco-McLennan County Public Health District

225 West Waco Drive

Waco, Texas 76707

254- 750-5459

rogerb@ci.waco.tx.us

Marcia Becker

Texas Department of State Health Services

1100 West 49th Street

Austin, Texas 78756

512- 458-7287

marcia.becker@dshs.state.tx.us

Sandra Benavides-Vaello, RN, MPAff, PhD©

Texas Association of Community Health Centers

5900 Southwest Parkway, Building 3

Austin, Texas 78735

512- 329-5959

sbvaello@

Patricia Diana Brooks, MEd, MS

Retired

7235 Sharpview Drive

Houston, Texas 77074

pdb879@

Bing Burton, PhD

Denton County Health Department

306 N. Loop 288, Suite 183

Denton, Texas 76021

940- 349-2900

bburton@

Catherine Cooksley, DrPH

UT MD Anderson Cancer Center

1515 Holcombe Blvd. Unit 447

Houston, Texas 77030

713- 563-4304

ccooksle@

Nancy Crider, MS, RN

Texas Public Health Training Center

1200 Hermann Pressler Drive

Houston, Texas 77054

713- 500-9399

nancy.m.crider@uth.tmc.edu

Mike Czepiel, BBA

Texas DSHS

1100 West 49th Street

Austin, Texas 78756

512- 458-7770

michael.czepiel@dshs.state.tx.us

Rick Danko, DrPH

Texas Department of State Health Services

1100 West 49th Street

Austin, Texas 78756

512- 458-7375

rick.danko@dshs.state.tx.us

Mary des Vignes-Kendrick, MD, MPH

Texas A & M Health Science Center, School of Rural Public Health

2121 West Holcombe Blvd, Suite 1111D, Houston, Texas 77030

713- 677-7430

mdkendrick@srph.tamhsc.edu

Rachelle Smith Doody, MD, PhD, Baylor College of Medicine

One Baylor Plaza, MS NB302

Houston, Texas 77030

713- 798-7416

rdoody@bcm.edu

Eva Dunn

Gateway Community Health Center, Inc.

1515 Pecan Street

Laredo, Texas 78041

956- 523-3671

Myrna Esquivel, MS

Lead-Based Paint Hazard Control Program, Neighborhood Services Department

1400 South Flores

San Antonio, Texas 78204

210- 207-6628

myrna.esquivel@

Seri Essary, BS, RS

Texas Department of State Health Services

1100 West 49th Street

Austin, Texas 78756

512- 834-6770

seri.essary@dshs.state.tx.us

Doug Fabio, MHA

Tarrant County Public Health

1101 S. Main Street

Fort Worth, Texas 76104

817- 321-5316

dfabio@

Deborah Flaniken

East Texas AHEC/UTMB

301 University Blvd

Galveston, Texas 77555

409- 772-7884

deborah.flaniken@utmb.edu

Susan Franzetti, MSN, RN

Pflugerville ISD

16229 FM 973N #3

Manor, Texas 78653

512- 594-0127

susan.franzetti@

Alexandra Garcia, PhD, RN

UT School of Nursing

3402 Larry Lane

Austin, Texas 78722

512- 474-7532

agarcia@mail.nur.utexas.edu

Hector Gonzalez, MD, MPH

City of Laredo Department of Public Health

2600 Cedar Avenue

Laredo, Texas 78040

956- 795-4920

hgonzalez@ci.laredo.tx.us

Fernando A. Guerra, MD, MPH

San Antonio Metropolitan Health District, 332 W. Commerce

San Antonio, Texas 78205

210- 207-8731

fernado.guerra@

Paul B. Handel, MD

Health Care Service Corporation

901 S. Expressway

Richardson, Texas 75080

972- 766-3333

paul_handel@

Janice Hartman, RS

Texas Department of State Health Services

821 Brian Drive

Grand Prairie, Texas 75052

972- 264-2346

hartwoman7@

Linda Hook, RN, BSN, MSHP

University Health System

223 Mackenzie

New Braunfels, Texas 78130

210- 414-7578

bhook3115@

Joan Hutton, BA, RN, CPC

The Hutton Group, Inc., Vero Beach, FL

1855 Bridgepointe Circle, Unit 23

Vero Beach, Florida 32967

772- 770-1787

info@

Larry Johnson

Abilene-Taylor County Public Health District

850 N 6th Street

Abilene, Texas 79601

325- 692-5600

larry.johnson@

Isaac Joyner, MPH

City of Houston Department of Health & Human Services

8000 N. Stadium Drive 8th Floor

Houston, Texas 77054

713- 794-9286

isaac.joyner@

Linda Kaufman, MSN, RN, CS

San Antonio Metropolitan Health District

8210 Campobello Drive

San Antonio, Texas 78218

210- 434-1079

lkaufman@

Janice Knebl, DO

Texas College of Osteopathic Medicine

855 Montgomery Avenue

Fort Worth, Texas 76107

817- 735-2200

jknebl@hsc.unt.edu

Richard Kurz, PhD

UNTHSC School of Public Health

3500 Camp Bowie Blvd. EAD-749

Fort Worth, Texas 76112

817- 735-2323

rkurz@hsc.unt.edu

David Lakey, MD

Texas Department of State Health Services

1100 West 49th Street

Austin, Texas 78756

512- 458-7375

david.lakey@dshs.state.tx.us

Kathi Light, MSN, RN

University of the Incarnate Word, 4301 Broadway

San Antonio, Texas 78209

Scott Lillibridge, MD

Texas A & M Health Science Center, School of Rural Public Health

2121 West Holcombe Blvd, Suite 1111, Houston, Texas 77030, 713- 677-7766

lillibridge@srph.tamhsc.edu

Hardy Loe, Jr., MD, MPH

Consultant, 1659 Harold Street, Apt. B

Houston, Texas 77006

713- 524-2682

hardyloe@

Charles Macias, MD, MPH

Baylor College of Medicine

6621 Fannin Street, Suite A210, Houston, Texas 77030

832- 824-5416

cgmacias@

Michelle Malizia, MA

National Library of Medicine at HAM/TMC Library

NN/LM/SCR 1133 John Freeman Blvd

Houston, Texas 77030

713- 799-7880

michelle.malizia@exch.library.tmc.edu

Camille Miller

Texas Health Institute

8501 N. MoPac, Suite 420

Austin, Texas 78759

512- 279-3904

cmiller@

Catherine Pepper, MLIS, MPH

Centers for Disease Control & Prevention

1600 Clifton Rd. NE, MS E-08

Atlanta, GA 30333

404- 639-6018

cpepper@

Dennis Perrotta, PhD

Texas A & M Health Science Center, School of Rural Public Health

358 Gotier Trace Road

Smithville, Texas 78957

512- 217-9042

epidemic@

Lourdes Rangel

Gateway Community Health Center

1515 Pappas Street

956- 523-3644

lulur.gateway@

Janet Realini, MD, MPH

San Antonio Metropolitan Health District

332 West Commerce Street #303, San Antonio, Texas 78205

210- 207-8850

janet.realini@

Brenda Reyes, MD, MPH

City of Houston Health & Human Services

8000 N. Stadium Drive, 2nd Floor, Houston, Texas 77054

713- 794-9452

brenda.reyes2@

Roger Rosenberg, MD

UT Southwestern Medical Center-Dallas

5323 Harry Hines Blvd.

Dallas, Texas 75390

214- 648-3239

roger.rosenberg@utsouthwestern.edu

William M. Sage, JD, MD

University of Texas, School of Law

727 East Dean Keaton Street

Austin, Texas 78705

512- 232-7806

wsage@law.utexas.edu

Eduardo Sanchez, MD, MPH

Institute for Health Policy, UTSPH

313 East 12th Street, Suite 220

Austin, Texas 78701

512- 482-6164

eduardo.sanchez@uth.tmc.edu

Jeff Savage, BS

Arthritis Foundation, Texas Chapter

4300 MacArthur Ave, Suite 245

Dallas, Texas 75209

214- 826-4361

jsavage@

Randolph Schiffer, MD

Texas Tech University, School of Medicine, Lubbock

806- 743-2249

Bobby Schmidt, MEd

Alzheimer's Disease Program-Texas Department of State Health Services

PO Box 149347

Austin, Texas 78714

512- 458-7111

bobby.schmidt@dshs.state.tx.us

Steven Shelton, MBA, PA-C

UTMB

301 University Blvd

Galveston, Texas 77555

409- 772-7884

steve.shelton@utmb.edu

Sam Shore, Mental Health Transformation Operations Director, DSHS

909 W. 45th Street, Austin, TX 78756, 512-458-7135

Sam.shore@dshs.state.tx.us

Jennifer Smith

Texas Department of State Health Services

1100 West 49th Street

Austin, Texas 78756

512- 458-7111

jennifer.smith@dshs.state.tx.us

Sandra Strickland, DrPH

University of the Incarnate Word

508 Highway 90E

Castroville, Texas 78009

210- 829-3988

strickla@uiwtx.edu

Ginny Thompson, MPH, CHES

National Cancer Institute's Cancer Information Service, MD Anderson Cancer Center

1515 Holcombe Blvd, Unit 229

Houston, Texas 77030

713- 792-8091

gthompson@

Catherine Tull, DVM

Texas Department of State Health Services, Region 8

7430 Louis Pasteur Drive

San Antonio, Texas 78229

210- 949-2000

catherine.tull@dshs.state.tx.us

Helena M. VonVille

The University of Texas School of Public Health at Houston

1200 Hermann Pressler RASE-119

Houston, Texas 77030

713- 500-9131

helena.m.vonville@uth.tmc.edu

Stephen Waring, DVM, PhD

UT School of Public Health

1200 Pressler

Houston, Texas 77030

713- 500-9241

stephen.c.waring@uth.tmc.edu

Stephen L. Williams, MEd, MPA

City of Houston Department of Health & Human Services

8000 N. Stadium Drive 8th Floor

Houston, Texas 77054

713- 794-9311

stephen.williams@

Exhibitors and Sponsors

Alzheimer's Disease Program

DSHS

Bobby Schmidt, MEd

PO Box 149347, Austin, Texas 78714

512- 458-7111

512- 458-7254

bobby.schmidt@dshs.state.tx.us

Centers for Medicare & Medicaid Services

Melissa Scarborough, MPH, CHES

1301 Young Street, Room 714, Dallas, Texas 75202

214- 767-4407/214- 767-6400

melissa.scarborough@cms.

Channing Bete Company

Susann Johnson

One Community Place, South Deerfield,MA 01373

413- 665-6414/413- 665-7117

jsmith@channing-

East Texas AHEC/UTMB

Deborah Flaniken

301 University Blvd, Galveston, Texas 77555

409- 772-7884/409- 772-7886

deborah.flaniken@utmb.edu

Environmental & Injury Epidemiology and Toxicology Branch-DSHS

Maribel Garcia Valls

1100 West 49th Street, Austin, Texas 78756

512- 458-7269/512- 458-7222

maribel.valls@dshs.state.tx.us

Glaxo SmithKline Vaccines

Chris Lowry

512- 787-0708

chris.lowry@

Netsmart Technologies

Michael Sheppard

3500 Sunrise Highway,

Suite D-122, Great River, NY 11739

inquiry@

800-421-7503/631-968-2123

Nurse Oncology Education Program (NOEP)

Lisa Watson

7600 Burnet Road, Suite 440

Austin, Texas 78757

512- 467-2803/512- 467-0834

lwatson@

Organon, a part of Schering-Plough

Tamra Wilcoxson

56 Livingston Avenue, Roseland, NJ 07068

281- 250-2305/973- 325-5395

t.wilcoxson@

Texas Health Steps-DSHS

Velma Stille

7430 Louis Pasteur Drive, San Antonio, Texas 78209

210- 949-2159/210- 949-2047

velma.stille@dshs.state.tx.us

Texas Public Health Training Center

Nancy Crider, MS, RN

1200 Hermann Pressler Drive, Houston, Texas 77054

713- 500-9399/713- 500-9397

nancy.m.crider@uth.tmc.edu

Texas Vaccines for Children Program-DSHS

Alma Chavez, AFIX Consultant

PO Box 149347, Austin, Texas 78714-9347

512- 458-7284/512- 458-7288

alma.chavez@dshs.state.tx.us

The Glenda Dawson Donate Life

Texas Registry-DSHS

Joseph Struble

1100 West 49th Street, Austin, Texas 78756

512- 458-7111/512- 458-7238

joseph.struble@dshs.state.tx.us

University of Texas-Health Science Center at Houston

Irmgard Willcockson, PhD

7000 Fannin Suite 600, Houston, Texas 77030

713- 500-3627/713- 500-3907

irmgard.willcockson@uth.tmc.edu

University of Texas

Health Science Center Libraries

Julie Gaines

7703 Floyd Curl Drive MC 7940, San Antonio, Texas 78229

210- 567-2464/210- 567-2490

gaines@uthscsa.edu

University of Texas School of Public Health

Stephanie Tamborello

1200 Hermann Pressler, E-209, Houston, Texas 77054

713- 500-9030/713- 500-9068

stephanie.m.tamborello@uth.tmc.edu

UNT Health Science Center

School of Public Health

Erin Carlson

3500 Camp Bowie Blvd., Fort Worth, Texas 76112

817- 735-5046/817- 735-2619

ecarlson@hsc.unt.edu

US Army Reserve Physician Recruiting

Keith Lehman

2001 S. Hanley Road, Suite 540, St. Louis, MO 63144

702- 572-4711/314- 646-8795

keithl@

Wyeth Vaccines

Clifford S. Pumphrey, Jr.

727 Alendale Drive, Coppell, Texas 75019

972- 897-0180/972- 393-3364

pumphrec@

Public Health Presentations

Papers

Intentional Poisoning Exposures Reported to the Texas Poison Control Center, Marcia Becker, MPH, CHES

Target audience: Educators, Health care providers, Public Health officials and practitioners as well as concerned public participants.

How the need was established: The need for research into intentional poisoning was established when it was recognized last spring that this was an area among intentional injuries/exposures that was increasing rather than decreasing in annual incidence for Texas. Recent publications confirm national trends as increasing intentional poisoning cases, particularly among female youth 15 to 19 years of age. Texas data indicate that females 20 to 29 years of age have the highest rate (7.4/100,000 population) for intentional poisoning exposures. These are serious events which resulted in 383 deaths from 2000 through 2006 in Texas. The majority of these exposures were determined to be intentional poisoning for suspected suicide.

Objectives:

To determine who is at highest risk of intentional poisoning exposures in Texas

To determine what particular substances are involved in the intentional poisonings in Texas

To gain an understanding of the treatment and health outcomes of intentional poisonings in Texas

To increase awareness of this issue while addressing healthcare and educational resources needed to combat this increasing concern.

Inpatient Admissions for Infection in Cancer Patients: Impact of an Aging Population, Catherine D. Cooksley DrPH, Elenir B. C. Avritscher MD, MBA/MHA, Linda S. Elting, DrPH, Health Services Research Section, Division of Quantitative Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, Funded in part by the William Randolph Hearst Foundations

Target Audience: Epidemiologists, healthcare administrators, policy makers, nurses, physicians and other healthcare professionals

How need for research project was established: It is expected that improved life expectancies and the aging of the US population will present substantial financial and logistic challenges to future healthcare provision. Development of strategies to reduce the burden on healthcare providers and payers is essential to improve quality of life of seniors, control costs and prevent further stress on the healthcare system.

Objectives of research:

• Estimate future cancer prevalence

• Estimate incidence of inpatient admissions for infection among patients with cancer

• Project future incidence and economic burden of infection in patients with cancer

• Describe resource utilization and costs associated with such infections

• Examine impact of the aging U.S. population on future hospital admissions for infection in patients with cancer

Background: Cancer patients are particularly susceptible to infections. As cancer prevalence increases due to an aging U.S. population (a 73% increase is expected by 2025), so will the population at risk for infections.

Methods: From the 2001 Texas discharge data, we identified all cancer patients’ hospitalizations which had pneumonia, bacteremia or wound infection as the admitting or principal diagnosis. We used 2003 Surveillance Epidemiology End Results (SEER) age-specific cancer prevalence estimates and 2006 and 2025 US census population projections to estimate future healthcare system burden (costs and total hospital bed days utilized) due to these infections. We inflated charges to 2006 US$ using Consumer Price Index for Medical Care and derived costs using 2006 Texas Medicare cost-to-charge ratios.

Results: Over 18,000 TX inpatients discharged in 2001 had a cancer diagnosis and a potentially preventable infection. Nationally, an estimated total of 318,164 cancer patients were hospitalized for infection in 2006 at a cost of $3.1 billion (B) (95% CI $2.8B, $3.4B) and utilizing a total of 2.3 million bed days. Assuming no change but the aging of the population, projected costs by 2025 could increase 45% to $4.5B (95% CI $4.1B, $4.9) with 27% more (3.4 million) hospital bed-days utilized.

Conclusions: Implementing measures aimed at preventing serious infections in the vulnerable cancer population may reduce healthcare system burdens as the population ages and cancer prevalence rises.

Following the Roadmap to Preparedness Data: Creating a Public Health Preparedness Dashboard, Catherine Pepper, MLIS, MPH, Vipat Kuruchittham, PhD, Robert Lazo, MS, MS, Lisa Tuttle, Rebecca Petrie, MPH, Donald Ward, Sara Thrift, MLIS, Herman Tolentino, MD

Affiliation: Centers for Disease Control and Prevention, Atlanta, GA 30333; Maine Center for Disease Control, Augusta, ME, 04330

Target Audience: Preparedness and syndromic surveillance specialists, data managers, informaticians, IT specialists, public health administrators, disease surveillance specialists, epidemiologists, and others involved and interested in tools for data analysis, visualization, and reporting.

Objectives:

1. To identify and document all data elements and processes that relate to preparedness, and create context mapping of information flow between stakeholders via business process analysis.

2. To develop a prototype graphical design for a preparedness dashboard, including data models (data flow diagrams and entity-relationship diagrams) of component systems.

Abstract: A dashboard is defined as a graphical user interface that organizes and presents information in a format that is easy to read and interpret.1 Dashboards have long been used as a tool in business to consolidate financial and performance reports into a streamlined visual display for management. Recently the dashboard concept has been modeled in the public health domain. Dashboards have been implemented by state and local health departments to provide access to various types and sources of information related to emergency, disaster, and bioterrorism preparedness.2 3 In response to a request from a state health department, we investigated the feasibility of integrating data from various sources into one desktop tool. Data collection was performed by structured interviews with key informants to ascertain their information needs and preparedness data accessed. In a “parallel design”4 session, participants drew their own dashboards, then discussed the components and designs they had incorporated. We subsequently created a prototype preparedness dashboard. The presentation illustrates the contribution of public health informatics5 to what may be ostensibly perceived as an “IT project,” particularly the need to approach such projects from a business process and organizational perspective, which requires the engagement of internal and external stakeholders for success.

References

1. Few S. Information dashboard design. Sebastopol, Calif.: O'Reilly; 2006:223.

2. Foldy SL, Biedrzycki PA, Baker BK, et al. The public health dashboard: A surveillance model for bioterrorism preparedness. Journal of Public Health Management & Practice. 2004;10:234-240.

3. Masum H, Singer PA. A visual dashboard for moving health technologies from "lab to village". J Med Internet Res. 2007;9:e32.

4. Bailey B. Consider as many design alternatives as possible: The value of parallel design. Available at:

. Accessed October 4, 2007.

5. Yasnoff WA, O'Carroll PW, Koo D, Linkins RW, Kilbourne EM. Public health informatics: Improving and transforming public health in the information age. J Public Health Manag Pract. 2000;6:67-75.

Assessment of Evidence-Based Prevention Practices within a Residency-based Family Practice Center, Linda Hook, RN, Norlynn Ripps, RN, Cathy White, RN, Graduate Students from the University of the Incarnate Word

Target Audience: Public health practitioners, nurses, and physicians

Need for Project: Requested by the agency to understand how to make improvements in efficiency and effectiveness based on current literature regarding the concept of an integrated medical home.

Objective: To apply microsystem analysis in accessing the incorporation of Partnership for Prevention™ practices within a residency based family practice center.

Using recommendations from the Institute of Medicine Crossing the Quality Chasm (2001), and the Dartmouth College Assessing Your Practice “The Green Book” (2004), the project examined the coordination of patient care, the management of evidence-based knowledge and skills, the presence of multi-disciplinary teamwork, and the utilization of information technologies at a residency based family practice center.

The Center exists as a microsystem within a larger not-for-profit comprehensive health care system whose mission and core values are directed at respecting the dignity of the patients served. The Center’s diverse staff excels in the fundamental areas of medical practice including the use of the electronic medical records (EMR). A review of literature calls to action the need to change the current primary care paradigm from responding to episodic, acute, technology-driven activities of medical practice to implementing a holistic, integrated, anticipatory-based healthcare system (Cifuentes et al., 2005; Woolf, et al., 2005; Satcher, Nussbaum, Woolf, & Strange, 2006).

Clinical observations and review of 30 patient records revealed opportunities for implementing the Partnership for Prevention™ recommendations. Data revealed redundant processes in mandatory immunization reporting, inconsistent and varying proficiencies in EMR, and under-developed EMR templates incorporating Partnership for Prevention™ recommendations.

Hispanic Ethnicity and Foreign Nativity as Predictive Factors of Community Health Center Utilization as a Regular Source of Care, Erin K. Carlson, M.P.H. and Nuha A. Lackan, Ph.D. , University of North Texas Health Science Center, Fort Worth, TX

Target Audience: Policymakers, community stakeholders, and advocates for Hispanic immigrants and/or community health center expansion

Need for Research:

Many Hispanics rely on the health care safety net for care. Approximately one-third of Hispanics are without health coverage and a growing portion of the Hispanic population are immigrants, presenting additional barriers to access and care. Community health centers (CHCs) are an integral part of the safety net for care to the rapidly growing Hispanic immigrant population. CHCs are consistently mentioned in literature as a means to improving access to care and health outcomes for Hispanic immigrants and are recognized for their culturally competent provision of care. However, little quantitative evidence is documented reporting the extent to which Hispanic immigrants utilize CHCs and the characteristics of the Hispanic immigrants who use CHCs. Empirical data is needed to inform community leaders who seek to expand access to health care to Hispanic immigrants about whether a CHC is a viable option in serving the needs of the population it is intended to serve. Results will inform current policy recommendations for CHC expansion as a means to improve health care for Hispanic immigrants.

Research Objective:

This research describes the extent to which CHCs are utilized as a regular source of care among Hispanic immigrants compared to Hispanics of U.S. nativity and other racial and ethnic groups. This study also identifies the demographic characteristics of Hispanic immigrants who use CHCs.

Methods:

The study analyzes nationally-representative 2001 Commonwealth Fund Health Care Quality Survey data (n=6,306). Univariate and bivariate analyses describe CHC utilization. Multivariate analyses model race, ethnicity, and U.S. nativity as predictors of CHC utilization.

Results:

The subgroup of 209 Hispanics who used a CHC as their regular source of care was significantly associated with insurance status, age, income, poverty threshold, and education. Four-fifths reported annual incomes below $35,000. Nearly 62% were uninsured and 68% were under age 40. Finally, 70.8% were born outside the U.S.

CHC utilization was greater for foreign-born Hispanics than other racial/ethnic groups. One-third of foreign-born Hispanics reported using a CHC as a regular source of care. Multivariate analyses found that only foreign-born Hispanic and non-Hispanic white were significant ethnic/racial predictors of CHC use. Foreign-born Hispanics were more likely to use CHCs over another care source than any of the other five groups.

Conclusions:

Hispanic immigrants were twice as likely to use a CHC as a regular care source compared to another care source. U.S.-born Hispanics, non-Hispanic immigrants, and non-Hispanic minorities were not significantly associated with CHC. CHCs provide well-utilized care to Hispanic immigrants. Policymakers seeking to increase care for Hispanic immigrants should consider expanding CHC capacity.

Posters

Uninsurance, the Local Safety Net and Preventable Hospitalizations in Harris County, Texas, YF Lee and JM Swint, University of Texas School of Public Health, Houston, Texas (Student Travel Scholarship Recipient)

In 2004 the Harris County (Texas) uninsurance rate was in excess of 30% and 75% of the demand for primary care from the safety net population was not met. Our objective was to examine how the uninsurance rate and local safety net may affect access to primary care for Harris County. The data from this study were collected from the Texas Health Care Information Collection, Census 2000 and Project Safety Net.

The applied methodology was small area analysis, with ZIP Codes as the unit of analysis. The outcome examined was the preventable hospitalization rate for non-elderly adults in the safety net population for each ZIP Code. Preventable hospitalizations are often used as an indicator of lack of access to care. Patient Quality Indicators, with the exception of low birth weight, were used as our inclusion criteria for preventable hospitalizations in this study.

The preliminary results suggest that an increase in the uninsurance rate was strongly associated with an increase in preventable hospitalizations. However, this significant association diminished as the poverty, education, and non-whites covariates were added to the model. There was not a statistically significant association between the existence of local safety net clinics and preventable hospitalizations.

Cost Drivers of Texas Medicaid Perinatal Care, Jimmy Blanton, MPAff, David Lynch, MA, Judy Devore, PhD, Cheryl Bowcock, MPH, Judy Temple, MSSW, and Gary Rutenberg, PhD

Target audience: Public health administrators, related professionals

Summary: Since SFY 2000, perinatal diagnoses have maintained a stable share of overall Medicaid spending for inpatient hospitalization. In SFY 2000, pregnancy and childbirth accounted for 65% of hospitalizations and 43% of expenditures, remaining the same through SFY 2006. However, during this same six year period, Medicaid spending for perinatal inpatient care increased by about $175 million. An estimated $50 million additional dollars were spent for professional fees associated with these hospital stays. While this spending growth is proportional to increases for other types of inpatient care, examination of hospital claims for pregnancy and childbirth shows that almost all of the additional expenditures are due to three specific cost drivers:1) an increase in the number of non-citizen residents whose maternal and infant health care costs were paid for by Medicaid, 2) An increase in the rate of newborns delivered via cesarean section, and 3) An increase in the Medicaid reimbursement rate for neonates born with extreme immaturity or respiratory distress syndrome.

Gender and Age Differences in Blood Utilization and Length of Stay in Radical Cystectomy: A Population Based Study, Marylou Cárdenas-Turanzas*, M.D. Dr. P.H., Catherine Cooksley, Dr. P.H., Ashish M. Kamat, M.D., Curtis A Pettaway, M.D., Linda S. Elting, Dr. P.H.

Names and affiliations of authors: M. Cárdenas-Turanzas, C. Cooksley and L. Elting.

Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Unit 447, Houston, TX 77030, USA.

AM. Kamat and CA. Pettaway

Department of Urology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Unit1373, Houston, TX 77030, USA.

*Presenter

Purpose: Radical cystectomy is a major surgical procedure associated with significant blood loss and lengthy hospital stays. This surgical procedure is more challenging in women than men due to anatomical based differences. We evaluated resource utilization and complication rates of patients undergoing radical cystectomy or exenteration using the Texas Hospital In-patient Discharge Data Collection.

Materials and Methods: Retrospective study of 1493 patients, 35 years of age or older, who underwent radical cystectomy for bladder cancer from January 2000 to December 2003. We evaluated blood product charges, length of stay, and complication rates during hospitalization.

Results: In this sample, 24% of the patients (n = 356) were women. Overall, women had significantly increased blood product charges and length of stay compared to men, $1392.87 vs. $718.21 (p < 0.001) and 12.72 vs. 11.64 (p = 0.03), respectively. During hospitalization, 26 of the patients died. No differences in mortality or complication rates were observed between men and women.

Multivariate analysis showed that female sex (p < 0.001) and age (p = 0.003) were independent predictors of increased blood product charges. Multivariate analysis showed that female sex (p = 0.015), age (p = 0.003) and Charlson’s comorbidity index > 2 (p = 0.05) were predictors of longer length of stay.

Conclusions: Women and older patients with bladder cancer are at risk of increased blood products utilization and length of hospital stay after a radical cystectomy. Future research should focus on improving postoperative outcomes for these vulnerable patients.

Human Papillomavirus Vaccine Knowledge and Attitudes in Texas – Texas BRFSS, 2007, Rebecca A. Wood, MSHP; Michelle L. Cook, MPH

Target Audience: Epidemiologists, researchers, public health administrators, physicians and other public health professionals interested in HPV vaccination knowledge and attitudes in Texas.

Background/Need: The first vaccine to protect against four types of human papillomavirus (HPV) most commonly associated with causing cervical cancer was licensed by the Federal Drug Administration in June of 2006. The Advisory Committee on Immunization Practices recommends the routine vaccination of 11-12 year old females with three doses of quadrivalent HPV vaccine. Limited data have been collected on the knowledge and attitudes of men and women concerning HPV vaccination recommendations.

Objectives: To examine the knowledge of and attitudes toward the new HPV vaccine in Texas.

The Heath Resources and Services Administration and Harris County Hospital District, Health Care for the Homeless Program: Working Together to Impact the Plight of the Homeless in Harris County, Princess D. Jackson, MS, Wanda I. De Mello, MBA, Co-Authors: Kevin Bartlett, RN, MSN, Marion Scott, RN, MSN, Susan Spalding, MD

Target Audience: Health Care for the Homeless Program Administrators, Public Health Officers, Community health Centers Administrators, and other Public health Professionals.

Objectives of Project: To identify factors impacting the homeless population ability to access health care services and effective strategies to increase the awareness and use of existing health care services for the target population.     

How need for research of project was established: Health Resources and Services Administration (HRSA) Office of Performance Review (OPR) conducts performance reviews to assure organizations receiving HRSA funds are successfully accomplishing their programs goals and objectives. In 2007, the Dallas Regional Division of the OPR conducted a performance review with the HCHP to identify the successes and challenges faced by the organization in increasing access to health services to homeless individuals and families in a large metropolitan area in the United States. In addition, there is a need to address limitations within the service delivery system so strategies can be developed to improve and increase access of health care service to the homeless.

Abstract: The Health Resources and Services Administration (HRSA), Dallas Regional Division (DRD) Office of Performance Review (OPR) conducted a performance review with Harris County Hospital District – Health Care for the Homeless Program (HCHP) to address the successes and challenges faced by the organization in increasing access to the homeless population in Harris County.  A protocol was developed to collect quantitative and qualitative data to analyze factors that impacted the program’s service delivery of healthcare to the population. The OPR findings indicated the following: independently operated shelters’ policies impact the homeless’ ability to give priority to their medical needs, revitalization of the downtown area has forced the homeless to move out and away from traditional service provider networks, and homeless individuals and families migrating to the city or not living in shelters are unaware of the health care services available for them. Given these findings, the following strategy was recommended: increase communication and partnerships between shelters, agencies and government officials to promote the increase of healthcare services through outreach efforts.

Introduction:

The HRSA OPR plays a central role in achieving HRSA’s mission by reviewing and enhancing the performance of HRSA supported programs within communities and States. The purpose of OPR performance reviews is to improve the performance of HRSA supported programs by working collaboratively with grantees to measure program performance, analyze the factors impacting performance and identify effective strategies to improve performance. In 2007, the Dallas Regional Division (DRD) OPR conducted a performance review with Harris County Hospital District – Health Care for the Homeless Program (HCHP) to measure the organization’s impact in providing health care services to the homeless. The program began operations in 1988 and provides preventive and primary care, oral health and social and support services to homeless individuals and families. HCHP provides services in eleven health clinics in homeless shelters, two medical mobile units, one dental unit, and a day center to its target population. HCHP reports 100% of their clients are below the 200% Federal Poverty Level (FPL). The population served is approximately 52% African-American, 24% White, 13% Hispanic, and 11% other. Mental disorders, hypertension, diabetes mellitus and asthma are the most common medical diagnoses seen in the homeless population receiving services through the HCHP.

One of the measures selected for the review was the number of unduplicated homeless users receiving services through HCHP over the past four years. This performance measure was selected because it reflects the grantee’s efforts and HCHP goal of improving the health status and outcomes for homeless individuals and families by improving access to primary health care, mental health services, and substance abuse treatment. Moreover, the number of patients utilizing HCHP services is a significant indicator to measure the organization’s efforts in meeting healthcare needs and impact of services provided to this population.

Methodology: The OPR process focuses on the selection of performance measures that reflect the organization’s ability to measure its effectiveness in terms of effort and outcome. When measures are chosen, quantitative data is collected which will demonstrate the history of the program’s actual performance and compare the trend with the grantee’s projected performance. Qualitative data is gathered by a series of telephone and face-to-face interviews that take place over a 12-week period. Interviews are semi-structured and designed to support disclosures to take place in a non-threatening setting. The discussion oriented atmosphere is created to build trust and elicit honest answers from the participants. The focus of the discussions is to identify the restricting factors facing HCHP’s ability to increase access to health care for their target population. A root cause analysis is conducted of the restricting factors so systemic challenges can be identified and strategies developed that highlight the benefits of using a community wide approach to confront the issue. Throughout the process, the review team shared all data collected during the interviews with the organization’s stakeholders to promote transparency and trustworthiness.

Findings and Recommendations: The performance review process findings indicated policies of the shelters, which are independently operated, hinder the organization’s ability to give priority to the population’s medical needs. Likewise, the revitalization of the downtown Houston area has caused the homeless to move away from traditional service provider networks, which are usually located in metropolitan downtown areas. Lastly, because of the transient nature of the population, homeless individuals and families are not aware of the community’s variety of health care services available to them.

At the conclusion of the review, the following recommendations were suggested as methods to increase access to healthcare services to homeless individuals and families: First, increase communication with the shelters to educate, coordinate services and partner so the collaboration is successful for all stakeholders. Second, host meetings with the Coalition for the Homeless of Houston/Harris County, local advisory councils, city officials, police departments and associations involved in the improvement of Harris County to expand networking opportunities between the various local, city and county representatives so outreach activities in non-traditional service areas can be increased. Third, contact the National Law Center on Homelessness and Poverty. This agency assist organizations in implementing constructive alternative solutions to benefit all stakeholders involved with service delivery to the homeless population.

Keep Infants Sleeping Safely (KISS), Paola Tovar Kurth, MBA & Jann Rodriguez Carter, RN.

Objectives: To conduct newborn safe sleep training in 75% of Bexar County hospital’s Maternal-Child Units. Adoption of safe sleep practices in 50% of nurseries that participated in training, witnessed through open crib post intervention observations.

Target audience: Newborn nursery, labor and delivery and post-partum staff.

Need for Education: Despite a major decrease since 1992 in Sudden Infant Death Syndrome (SIDS) and the “Back to Sleep” campaign, more than 4,500 infants still die suddenly of no obvious cause in our country each year. Bexar County post-neonatal infant mortality rate is about 150% of the national average.

Abstract: Studies suggest that instituting new sleep recommendations in the nursery, as well as in the media that surrounds new parents, is likely to discourage parents from using the side position, propping, and/or swaddling at home (1,2). Maternal-Child hospital staff participated in training discussing (a.) research-based safe sleep practices, (b.) death statistics for the County and (c.) the importance of modeling correct positioning of newborns and creating a safe sleeping environment during the first 24-48 hours to help educate parents on the risk factors of SIDS. Surveys of newborn sleep environment and position in the crib were conducted in nurseries that agreed to the intervention. Observations were conducted in three stages: prior to the intervention, midcourse and at the end of project year 1. Educational materials for staff and parents were distributed at all hospitals that participated in the intervention.

Bibliography:

Colson ER, Joslin SC. Changing nursery practice gets inner-city infants in the supine position for sleep. Arch Pediatr Adolesc Med. 2002;156:717–720.

Willinger M, Ko CW, Hoffman HJ, Kessler RC, Corwin MJ. Factors associated with caregivers’ choice of infant sleep position, 1994–1998:the National Infant Sleep Position Study. JAMA. 2000;283:2135–2142.

Disparities in Access to Health Care among Children in the U.S. after SCHIP (1997 to 2005), Alicia C. Guerrero, M.P.H. & Stephanie McFall, Ph.D.

Target Audience: Disparities researchers, state and national health policy makers, child health care advocates.

Need for Research: Much of the literature on disparities in access to health care among children has focused on measuring disparities at a single point in time and with a focus on race/ethnic groups. This study examines change in income and racial/ethnic disparities in access to care over time within the child population. The period of change that will be examined coincides with implementation of major policy initiatives to enhance access to care for children, the State Children’s Health Insurance Program (SCHIP). The Relative Index of Inequality (RII) and the Population Attributable Risk (PAR) are two measures that will be used to quantify the change in disparities. These health inequalities measures use more information about the distribution of the disparities in the population to quantify the problem so comparisons aren’t limited to extreme groups (rich versus poor) or limited to just two groups (poor versus non-poor). The RII is a linear regression based estimate and thus can measure the access to care differences among ‘rich’ and ’poor’ income groups while taking into account the variation that occurs for income categories between these extremes when plotted appropriately. The PAR estimates the proportion of differences in access to care ‘attributable’ to being from a disadvantaged social group.

Figure 1. Scatterplot of the percent of Children Uninsured by the relative Income group position based on % of Federal Poverty Threshold, 1997-98 vs. 2004-05

Research Objectives

1) Use the Relative Index of Inequality (RII) and the Population Attributable Risk (PAR) to measure income and race/ethnicity disparities (respectively) in access to health care among children.

2) Using the RII and PAR, quantify the change in disparities in health insurance coverage and having a usual source of health care (access to care) after health insurance coverage became available through the SCHIP.

Abstract: The objective of the research was to determine if there was a decrease in disparities in access to care for children across income and race/ethnicity groups after SCHIP. The study used four years of data from the National Health Interview Survey to depict disparities prior to SCHIP (1997-1998) and six years after SCHIP (2004-2005). Access was measured by health insurance coverage and having a usual source of care. The Relative Index of Inequality (RII) and Population Attributable Risk (PAR) were used to measure and quantify the change in disparities. Based on these measures, there was a substantial decrease in income disparities in both health insurance coverage and having a usual source of care following SCHIP. There was also a considerable decrease in non-Hispanic Black disparities in both access to care indicators. .However, among Hispanic children there was no change in health insurance disparities and a slight increase in disparities in having a usual source of care. While there were great improvements in income disparities in access to care coinciding with the introduction of the SCHIP program, continuing progress in reducing race/ethnicity disparities may depend on continuation of the SCHIP program or similar targeted health coverage programs.

Hospitals and Environmental Variation in Texas Nonprofit Hospital Organizational Policies Regarding Charity Care, Mary Kathryn Martin, “Kate”

Target audience: Safety Net Providers

How need for research or education project was established: Approximately 25 percent of Texas residents are uninsured. Nonprofit hospitals are part of the safety net for persons who are indigent, low-income and uninsured. Texas was the first state to enact legislation (1993) specifying a percentage of revenues that tax-exempt hospitals must dedicate to community benefits. This “quid pro quo” of providing community benefits in exchange for tax exemption has become controversial. Hospitals use charity care to determine community benefits and meet Texas Health and Safety Code, §311.04610. This paper is the first review of charity care eligibility policies.

Objectives of research or education project:

Hospitals designated by state and federal governments as tax-exempt organizations enjoy tax relief benefits. Does the charity care provided by nonprofit hospitals equal the value of the tax exemption? Few studies have identified specific nonprofit hospital characteristics or discussed how these variations in characteristics may impact policies regarding charity care. Charity care policies are established by each nonprofit hospital. This study was undertaken to provide specific information about the charity care eligibility policies of nonprofit hospitals. The study examines hospitals characteristics-by physical location, bed size, disproportionate share, etc and county demographics to determine the relationship to charity care eligibility polices.

Beyond Fee-For-Service-Building Primary Care Infrastructure Capacity in Texas, Mary Kathryn Martin, “Kate”

Target audience: Government Contractors and Nonprofit Organizations

How need for research or education project was established: One hundred and seventy-seven counties in Texas are federally designated as Medically Underserved Areas (MUA) indicating high poverty, infant mortality, inadequate provider to patient ratios, etc. MUA designation is a requirement for health care organizations to be designated as Federally Qualified Health Centers (FQHCs). FQHCs receive federal grants and enhanced reimbursement for Medicaid and Medicare patients. The FQHC Incubator Program supports the development of new and expansion of existing FQHCs addressing access to primary care in MUAs. FQHCs have increased from 32 to 59 in five years.

Objectives of education project: The FQHC Incubator Program is designed to support the efforts and collaborations of local public and private nonprofit entities to develop FQHCs. Funds and technical assistance are provided for clinic start-up, sustainability, federal guideline compliance, and submittal of federal applications. The FQHC Incubator Program is vendor contract with a set of “deliverables” that parallel the federal program requirements. Deliverables must be completed to the satisfaction of the DSHS staff prior to approving reimbursement. However, developing, implementing, and measuring a “deliverables” contract program has not been without its difficulties. The poster will identify how these specific program requirements, problems/difficulties, etc have developed organizational infrastructure for the delivery of primary care in MUAs.

Use of Promotores to Improve Cardiovascular Health of Hispanics in Fort Worth, Texas, Erin K. Carlson, M.P.H. and Nuha A. Lackan, Ph.D. , University of North Texas Health Science Center, Fort Worth, TX

Target audience: Public health practitioners, providers and others interested in the use of lay health workers to improve health in underserved populations

Need for Research: Evidence suggests that effective prevention strategies engage the community. Such approaches are particularly utilized in Hispanic populations in response to Hispanics’ strong sense of community. Promotores de salud, Spanish for lay community health workers, offer health education to members of Hispanic communities and link those they serve with health services. Promotores have been effective at filling gaps in health services for medically underserved, socio-economically disadvantaged communities by providing culturally competent education to help individuals prevent the onset of or manage existing diseases. Several studies report the effectiveness of chronic disease interventions that employ promotores. Health outcomes that have been improved as a result of promotores interventions include self-reported health status, chronic disease management/prevention behaviors, and/or health knowledge from pre-test to post-test measures.

Research Objective: The purpose of this study was to conduct an educational intervention delivered by Promotores (lay Hispanic health workers) who would also serve as case managers to subjects in a Hispanic community. The intervention was aimed at improving cardiovascular health (CVH).

Methods: Individuals attending health fairs whose screening measurements indicated risk for developing cardiovascular disease were invited to enroll. Subjects were assigned to a Promotora for case management. Promotores attempted at least monthly contact with study subjects via phone, educational classes or home visits. Educational classes were conducted using the National Institutes of Health National Heart, Lung and Blood Institute curriculum for improving CVH. Subjects were invited to health fairs in January and March for interim and final measurements. Screening measures included: total cholesterol, LDL cholesterol, triglycerides, blood pressure and blood glucose.

Results: Seventy-seven subjects enrolled in the study. Only 16 (20.7%) subjects attended at least one class, and these subjects comprised the intervention group. The remaining 61 (79.2%) subjects comprised the control group, and were screened in both September and March. Over the study period, subjects in the intervention group realized reductions in fasting blood glucose levels, but did not have other substantive changes in cardiovascular health indicators.

Conclusions: Using promotores to deliver an educational intervention and serve as case managers can be effective in reaching Hispanic communities, though subject recruitment and retention must be emphasized throughout the duration of the study. (Source of support: UNTHSC EXPORT grant)

Kids Growing Healthy Program, Keisha Leatherman, Yvette Jones, Doug Fabio, Dana Tarter

Target Audience: 5th Grade Students

Need Statement: The need for a nutrition/physical activity program was established by reviewing various forms of primary and secondary data and research. The broad based need indicated in the Healthy People 2010 Objectives, as it relates to nutrition and overweight, is “to reduce obesity in children to 5 percent.” It is evident that trends in U.S. children mirror a similar increase over the same approximate time period as adults. However, on a more local level, we utilized the Tarrant County Public Health initiative, Monitoring & Assessment Project (M.A.P.) report and the 2004 Behavioral Risk Factor Surveillance System survey report to identify both target populations and areas. Two specific factors that were considered were: overweight/obesity morbidity rates and socioeconomic income levels in Tarrant County. In addition, we also reviewed Speaker Bureau Request Forms submitted by external cliental, paying close attention to subject of presentation and audience. We also found that a large percentage of requests were nutrition and/or physical activity based and were aimed at elementary/middle school-aged children.

Program Objective: To launch program into four different ISDs and reach 400 5th grade students during the school year throughout Tarrant County.

Participant Objective: To increase by 30 percent the students’ consumption of fruits and vegetables and/or physical activity.

Importance of measuring performance to identify key factors impacting the target population’s access to health care and effective strategies to improve performance, Wanda I. De Mello, MBA and Princess D. Jackson, MS; Co-Author(s): Cynthia L. Garcia, BA, David S. de la Cruz, Ph.D., MPH, Kirk Barnes, MCRP, Llamara Padro-Milano, BS, Robert Sappington, DMD, MPH, Shirley Henley, EdD, ANP

Target Audience: Maternal and Child Health Program Administrators, Public Health Officers, Community Health Centers Administrators, Continuous Quality Improvement (CQI) and Public Health Program Evaluators.

How need for research of project was established: Each year, Health Resources and Services Administration (HRSA) Office of Performance Review (OPR) conducts performance reviews to assure organizations receiving HRSA funds are successfully accomplishing their program goals. The purpose of OPR performance reviews is to improve the performance of HRSA supported programs by working collaboratively with grantees to select performance review measures, analyze factors that impacted performance in relation to the selected performance review measures, identify effective strategies to improve performance, and develop an action plan, which includes performance improvement actions to be completed by the grantee on each performance review measure selected. In 2007, the Dallas Regional Division (DRD) OPR conducted a performance review with Baptist Children’s Home Ministries - Healthy Start Laredo (HSL) Program to address the successes and challenges faced by the organization in increasing access to health services to women and their children living in the colonias of Webb County, Texas. Colonias are rural, mostly unincorporated communities located in California, Arizona, New Mexico, and Texas along the U.S.- Mexico border and are characterized by high poverty rates and substandard living conditions, such as lack of potable drinking water, water and wastewater systems, paved streets, and standard mortgage financing.

Objectives of Research: To increase knowledge of the importance of measuring public health programs performance, identify key factors impacting the target population’s access to health care, and describe strategies to improve performance.

Abstract: The Health Resources and Services Administration (HRSA) Office of Performance Review (OPR) conducted a performance review with Baptist Children’s Home Ministries - Healthy Start Laredo (HSL) Program to address the successes and challenges faced by the organization in increasing access to health services to women and their children living in the colonias of Webb County, Texas. The performance review measure selected was “The percentage of HSL women who stay in the program 24 months after delivery regardless of birth outcome.” Data analyzed indicated a progressive decline in the percent of women who stay in the program the complete time. The research revealed the reasons for the high attrition among HSL women were: status of parents, transiency of program participants, issues related to culture, and family priorities and commitments. In conclusion, to increase access to health services and retain women and their children living in colonias, public health programs should: bring access to the colonias (e.g., mobile units), build and maintain trust in the colonias, increase collaboration and partnerships with faith-based organizations, provide culturally and linguistically appropriate health education for the entire family, promote father involvement, and maintain a high level of promotion of health services available through outreach efforts.

Background: Each year, Health Resources and Services Administration (HRSA) Office of Performance Review (OPR) conducts performance reviews to assure that organizations receiving HRSA funds are successfully accomplishing their program purposes. The purpose of OPR performance reviews is to improve the performance of HRSA supported programs by working collaboratively with grantees to select performance review measures, analyze factors that impacted performance in relation to the selected performance review measures, identify effective strategies to improve performance, and develop an action plan, which includes performance improvement actions to be completed by the grantee on each performance review measure selected. In 2007, the Dallas Regional Division (DRD) OPR conducted a performance review with Baptist Children’s Home Ministries - Healthy Start Laredo (HSL) Program to address the successes and challenges faced by the organization in increasing access to health services to women and their children living in the colonias of Webb County, Texas.

Methodology: The OPR review team (public health analysts and maternal and child health consultant) and Maternal and Child Health Bureau (MCHB) Project Officer collaborated with the grantee for a period of twelve weeks to discuss the performance review process and select performance measures for the onsite performance visit and analysis of factors impacting performance. The performance measure “The percentage of HSL women who stay in the program 24 months after delivery regardless of birth outcome” was selected in collaboration with the HSL, OPR review team and Healthy Start program MCHB project officer. This performance measure was chosen because it reflects the MCHB Healthy Start programs goal of linking mothers and infants to a medical home and following them, at a minimum, from entry into prenatal care through two years after delivery (interconceptional care). HSL data of 117 interconceptional women who reported program start and end dates during the period 2005-2007 were used for the trend analysis. The OPR team visited the grantee for two days and met with all program staff to discuss performance trend, analyze the factors impacting performance, and identify strategies to improve performance.

Results: Of the 117 women, only 6% stayed in the program for 24 months after delivery. Data indicated a progressive decline in the percent of women who stay in the program as time progresses; from 55% retention (0-5 months) to 23% (6-11 months), 16% (12-17 months, and 6% (18-24 months). Some participant’s factors associated with the short stay in the Healthy Start program described by the HSL staff and client survey were: status of parents (program participants without legal residency constantly fear deportation and family separation), transiency of program participants (migration to different locations to be closer to family members, obtain basic needs and get away from border towns with high police activity, or to return to Mexico), issues related to culture such as husbands do not allow outsiders to contact their wife nor permit the wife to discuss personal or health issues, and family priorities and commitments (e.g. school, household duties, medical and non-medical appointments).

Conclusion: To increase access to health services and retain women and their children living in the colonias, public health programs should: bring access to the colonias (e.g., mobile units), build and maintain trust in the colonias, increase collaboration and partnerships with faith-based organizations providing support and assistance to the Hispanic population in the colonias, provide culturally and linguistically appropriate health education for the entire family, promote father involvement, and maintain a high level of promotion of health services available through outreach efforts.

Implications: Healthy Start programs and other public health programs working with women and children living in colonias should evaluate health education curriculum and services provided to ensure that a great amount of information is presented and needed services are prioritized and provided appropriately to the target population shortly after labor and delivery and before the women and children are lost to follow-up care.

Risk and Outcomes of Serious Postoperative Infections among Cancer Patients with Solid Tumors, Elenir B. C. Avritscher, Catherine D. Cooksley, Linda S. Elting

Target Audience: Public health community, infections control professionals, oncology researchers and clinicians.

How need for research was established: Cancer patients are at increased risk of infections because of treatment- and/or disease-related changes in their immune system. Infections during periods of chemotherapy-induced neutropenia have being extensively researched, due to its significant morbidity and mortality. However, postoperative infections among non-neutropenic cancer patients remain largely undescribed. Owing to the frequent surgical treatment of common solid tumors, there is a large population of solid tumor patients at risk for postoperative infections.

Objectives of research: To estimate the risk of serious infections and associated in-hospital mortality among patients with common intra-thoracic and intra-abdominal solid tumors undergoing surgery at the primary site of their cancers.

ABSTRACT: Background: Postoperative infections among solid tumor patients remain largely undescribed. We conducted a population-based study of morbidity and mortality of serious postoperative infections among patients with common intra-thoracic and intra-abdominal solid tumors.

Methods: All Texas residents with cancer of the lung, colon, rectum, bladder, pancreas, esophagus, or stomach who underwent surgeries at the primary site of their cancers in Texas between 1/1/1991 and 12/31/2001 were identified from the Texas Hospital Discharge Database. Patients who underwent emergency procedures were excluded. The billing records of the eligible pts were examined for ICD-9 codes indicating bacteremia or septicemia, pneumonia, wound abscess/infection.

Results: From 1999 to 2001, 17,085 procedures were conducted. Colorectal (52%), and lung (34%) cancers predominated. Postoperative infections occurred following 1,183 procedures (7%). The risk of postoperative infections varied significantly by primary cancer site; from 5% in the colon/rectum to 26% in the esophagus. Pneumonia alone accounted for over half of the infections. Inpatient mortality was significantly more common among patients with postoperative infections than those without (19% vs. 2%, p ................
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