Pathways to Health
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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.
2 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.
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
3 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
Public Health Presentations (Continued) WESTOVER ASSEMBLY AUDITORIUM
Following the Roadmap to Preparedness Data: Creating a Public Health Preparedness Dashboard,
4 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
5 6:45 – 7:30 pm TPHA Governing Council Meeting AGARITA
6:30 – 7:30am Health Walk (meet in hotel lobby) HOTEL LOBBY
7 am-4 pm Registration HOTEL LOBBY
6 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
7 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
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
8 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
Epidemiology AGARITA Moderator, Patricia Diana Brooks, MEd, MS 2007: Disasters in Review
9 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
10 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
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.
11 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
12 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
13 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.
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.
14 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
4:45 – 6:15 pm President’s Reception & Awards Presentations SUNSPOT/FOYER
15 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.
16 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
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- M.P.H, Janice Hartman, Vazquez, MPH, Epidemiology RS, Environmental Second Vice- Debra Edwards, Linda Hook, RN, President MS, RNC, ONC, BSN, MSHP, Patricia Diana Continuing President-Elect Brooks, MEd, MS, Education Linda Kaufman, First Vice- Doug Fabio, MHA, MSN, RN, CS, President Health Policy Public Health Julio Allo, MPH, Deborah Flaniken, Nursing Epidemiology General Session Hardy Loe, Jr., Catherine Alexandra Garcia, MD, Health Cooksley, DrPH, PhD, RN, Public Policy/General Website Health Nursing Session Nancy Crider, Pre- Karla Gutierrez, Amy Pearson, conference MPH, Continuing Mary desVignes- Epidemiology Education Kendrick, M.D, C. Lee Hamilton, Health Policy
17 Eduardo Sanchez, Dan Smith, MEd, Past President, MD, MPH, General CHES, Continuing Chronic Disease Session Education Cathy Troisi, PhD, Bobby Schmidt, Jennifer Smith, Health Policy General Session MSHP, Immediate 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
Presenters and Moderators
Bryan Alsip, MD, Waco, Texas 76707 Texas Association of MPH, FACPM 254- 750-5459 Community Health San Antonio [email protected] Centers Metropolitan Health 5900 Southwest District Marcia Becker Parkway, Building 3 332 West Commerce Texas Department of Austin, Texas 78735 San Antonio, Texas State Health Services 512- 329-5959 78205 1100 West 49th Street [email protected] 210- 207-8172 Austin, Texas 78756 bryan.alsip@sananton 512- 458-7287 Patricia Diana io.gov marcia.becker@dshs. Brooks, MEd, MS state.tx.us Retired Roger D. Barker, 7235 Sharpview Drive MBA (HCA), RS Sandra Benavides- Houston, Texas 77074 Waco-McLennan Vaello, RN, MPAff, [email protected] County Public Health PhD© District Bing Burton, PhD 225 West Waco Drive
18 Denton County Health 2121 West Holcombe dfabio@tarrantcounty. Department Blvd, Suite 1111D, com 306 N. Loop 288, Houston, Texas 77030 Suite 183 713- 677-7430 Deborah Flaniken Denton, Texas 76021 [email protected] East Texas 940- 349-2900 hsc.edu AHEC/UTMB bburton@dentoncount 301 University Blvd y.com Rachelle Smith Galveston, Texas Doody, MD, PhD, 77555 Catherine Cooksley, Baylor College of 409- 772-7884 DrPH Medicine deborah.flaniken@utm UT MD Anderson One Baylor Plaza, MS b.edu Cancer Center NB302 1515 Holcombe Blvd. Houston, Texas 77030 Susan Franzetti, Unit 447 713- 798-7416 MSN, RN Houston, Texas 77030 [email protected] Pflugerville ISD 713- 563-4304 16229 FM 973N #3 ccooksle@mdanderso Eva Dunn Manor, Texas 78653 n.org Gateway Community 512- 594-0127 Health Center, Inc. susan.franzetti@pflug 1515 Pecan Street ervilleisd.net Nancy Crider, MS, Laredo, Texas 78041 RN 956- 523-3671 Alexandra Garcia, Texas Public Health PhD, RN Training Center Myrna Esquivel, MS UT School of Nursing 1200 Hermann Lead-Based Paint 3402 Larry Lane Pressler Drive Hazard Control Austin, Texas 78722 Houston, Texas 77054 Program, 512- 474-7532 713- 500-9399 Neighborhood [email protected] [email protected] Services Department as.edu mc.edu 1400 South Flores San Antonio, Texas Hector Gonzalez, Mike Czepiel, BBA 78204 MD, MPH Texas DSHS 210- 207-6628 City of Laredo 1100 West 49th Street myrna.esquivel@sana Department of Public Austin, Texas 78756 ntonio.gov Health 512- 458-7770 2600 Cedar Avenue [email protected] Laredo, Texas 78040 ate.tx.us 956- 795-4920 Seri Essary, BS, RS [email protected] Rick Danko, DrPH Texas Department of x.us Texas Department of State Health Services State Health Services 1100 West 49th Street Fernando A. Guerra, 1100 West 49th Street Austin, Texas 78756 MD, MPH Austin, Texas 78756 512- 834-6770 San Antonio 512- 458-7375 [email protected] Metropolitan Health [email protected] e.tx.us District, 332 W. .tx.us Commerce Doug Fabio, MHA San Antonio, Texas Mary des Vignes- Tarrant County Public 78205 Kendrick, MD, MPH Health 210- 207-8731 Texas A & M Health 1101 S. Main Street fernado.guerra@sana Science Center, Fort Worth, Texas ntonio.gov School of Rural Public 76104 Health 817- 321-5316 Paul B. Handel, MD
19 Health Care Service 713- 794-9286 San Antonio, Texas Corporation isaac.joyner@cityofho 78209 901 S. Expressway uston.net Richardson, Texas Scott Lillibridge, MD 75080 Linda Kaufman, Texas A & M Health 972- 766-3333 MSN, RN, CS Science Center, [email protected] San Antonio School of Rural Public om Metropolitan Health Health Janice Hartman, RS District 2121 West Holcombe Texas Department of 8210 Campobello Blvd, Suite 1111, State Health Services Drive Houston, Texas 821 Brian Drive San Antonio, Texas 77030, 713- 677-7766 Grand Prairie, Texas 78218 [email protected] 75052 210- 434-1079 c.edu 972- 264-2346 lkaufman@sanantonio hartwoman7@sbcglob .gov Hardy Loe, Jr., MD, al.net MPH Janice Knebl, DO Consultant, 1659 Linda Hook, RN, Texas College of Harold Street, Apt. B BSN, MSHP Osteopathic Medicine Houston, Texas 77006 University Health 855 Montgomery 713- 524-2682 System Avenue [email protected] 223 Mackenzie Fort Worth, Texas New Braunfels, Texas 76107 Charles Macias, MD, 78130 817- 735-2200 MPH 210- 414-7578 [email protected] Baylor College of [email protected] Medicine 6621 Fannin Street, Joan Hutton, BA, RN, Suite A210, Houston, CPC Texas 77030 The Hutton Group, 832- 824-5416 Inc., Vero Beach, FL cgmacias@texaschildr 1855 Bridgepointe Richard Kurz, PhD enshospital.org Circle, Unit 23 UNTHSC School of Vero Beach, Florida Public Health Michelle Malizia, MA 32967 3500 Camp Bowie National Library of 772- 770-1787 Blvd. EAD-749 Medicine at HAM/TMC [email protected] Fort Worth, Texas Library om 76112 NN/LM/SCR 1133 817- 735-2323 John Freeman Blvd Larry Johnson [email protected] Houston, Texas 77030 Abilene-Taylor County 713- 799-7880 Public Health District David Lakey, MD michelle.malizia@exc 850 N 6th Street Texas Department of h.library.tmc.edu Abilene, Texas 79601 State Health Services 325- 692-5600 1100 West 49th Street larry.johnson@abilene Austin, Texas 78756 tx.com 512- 458-7375 [email protected] Isaac Joyner, MPH e.tx.us City of Houston Camille Miller Department of Health Kathi Light, MSN, RN Texas Health Institute & Human Services University of the 8501 N. MoPac, Suite 8000 N. Stadium Drive Incarnate Word, 4301 420 8th Floor Broadway Austin, Texas 78759 Houston, Texas 77054 512- 279-3904
20 cmiller@texashealthin Roger Rosenberg, Department of State stitute.org MD Health Services UT Southwestern PO Box 149347 Catherine Pepper, Medical Center-Dallas Austin, Texas 78714 MLIS, MPH 5323 Harry Hines 512- 458-7111 Centers for Disease Blvd. bobby.schmidt@dshs. Control & Prevention Dallas, Texas 75390 state.tx.us 1600 Clifton Rd. NE, 214- 648-3239 MS E-08 roger.rosenberg@utso Steven Shelton, Atlanta, GA 30333 uthwestern.edu MBA, PA-C 404- 639-6018 UTMB [email protected] 301 University Blvd Galveston, Texas Dennis Perrotta, PhD 77555 Texas A & M Health 409- 772-7884 Science Center, William M. Sage, JD, [email protected] School of Rural Public MD du Health University of Texas, 358 Gotier Trace School of Law Sam Shore, Mental Road 727 East Dean Keaton Health Transformation Smithville, Texas Street Operations Director, 78957 Austin, Texas 78705 DSHS 512- 217-9042 512- 232-7806 909 W. 45th Street, [email protected] [email protected] Austin, TX 78756, u 512-458-7135 Lourdes Rangel [email protected] Gateway Community Eduardo Sanchez, e.tx.us Health Center MD, MPH 1515 Pappas Street Institute for Health Jennifer Smith 956- 523-3644 Policy, UTSPH Texas Department of [email protected] 313 East 12th Street, State Health Services rg Suite 220 1100 West 49th Street Austin, Texas 78701 Austin, Texas 78756 Janet Realini, MD, 512- 482-6164 512- 458-7111 MPH eduardo.sanchez@uth [email protected] San Antonio .tmc.edu ate.tx.us Metropolitan Health District Jeff Savage, BS Sandra Strickland, 332 West Commerce Arthritis Foundation, DrPH Street #303, San Texas Chapter University of the Antonio, Texas 78205 4300 MacArthur Ave, Incarnate Word 210- 207-8850 Suite 245 508 Highway 90E janet.realini@sananto Dallas, Texas 75209 Castroville, Texas nio.gov 214- 826-4361 78009 [email protected] 210- 829-3988 Brenda Reyes, MD, [email protected] MPH Randolph Schiffer, City of Houston Health MD Ginny Thompson, & Human Services Texas Tech MPH, CHES 8000 N. Stadium University, School of National Cancer Drive, 2nd Floor, Medicine, Lubbock Institute's Cancer Houston, Texas 77054 806- 743-2249 Information Service, 713- 794-9452 MD Anderson Cancer brenda.reyes2@cityof Bobby Schmidt, MEd Center houston.net Alzheimer's Disease 1515 Holcombe Blvd, Program-Texas Unit 229
21 Houston, Texas 77030 The University of stephen.c.waring@uth 713- 792-8091 Texas School of .tmc.edu gthompson@mdander Public Health at son.org Houston Stephen L. Williams, 1200 Hermann MEd, MPA Catherine Tull, DVM Pressler RASE-119 City of Houston Texas Department of Houston, Texas 77030 Department of Health State Health Services, 713- 500-9131 & Human Services Region 8 helena.m.vonville@uth 8000 N. Stadium Drive 7430 Louis Pasteur .tmc.edu 8th Floor Drive Houston, Texas 77054 San Antonio, Texas Stephen Waring, 713- 794-9311 78229 DVM, PhD stephen.williams@city 210- 949-2000 UT School of Public ofhouston.net [email protected] Health ate.tx.us 1200 Pressler Houston, Texas 77030 Helena M. VonVille 713- 500-9241
Exhibitors and Sponsors Channing Bete Company Alzheimer's Disease Program Susann Johnson DSHS One Community Place, South Bobby Schmidt, MEd Deerfield,MA 01373 PO Box 149347, Austin, Texas 78714 413- 665-6414/413- 665-7117 512- 458-7111 [email protected] 512- 458-7254 [email protected] East Texas AHEC/UTMB Deborah Flaniken Centers for Medicare & Medicaid Services 301 University Blvd, Galveston, Texas Melissa Scarborough, MPH, CHES 77555 1301 Young Street, Room 714, Dallas, 409- 772-7884/409- 772-7886 Texas 75202 [email protected] 214- 767-4407/214- 767-6400 [email protected] Environmental & Injury Epidemiology and Toxicology Branch-DSHS
22 Maribel Garcia Valls 512- 458-7284/512- 458-7288 1100 West 49th Street, Austin, Texas [email protected] 78756 512- 458-7269/512- 458-7222 The Glenda Dawson Donate Life [email protected] Texas Registry-DSHS Joseph Struble Glaxo SmithKline Vaccines 1100 West 49th Street, Austin, Texas Chris Lowry 78756 512- 787-0708 512- 458-7111/512- 458-7238 [email protected] [email protected]
Netsmart Technologies University of Texas-Health Science Center Michael Sheppard at Houston 3500 Sunrise Highway, Irmgard Willcockson, PhD Suite D-122, Great River, NY 11739 7000 Fannin Suite 600, Houston, Texas [email protected] 77030 800-421-7503/631-968-2123 713- 500-3627/713- 500-3907 [email protected] Nurse Oncology Education Program (NOEP) University of Texas Lisa Watson Health Science Center Libraries 7600 Burnet Road, Suite 440 Julie Gaines Austin, Texas 78757 7703 Floyd Curl Drive MC 7940, San 512- 467-2803/512- 467-0834 Antonio, Texas 78229 [email protected] 210- 567-2464/210- 567-2490 [email protected] Organon, a part of Schering-Plough Tamra Wilcoxson University of Texas School of Public 56 Livingston Avenue, Roseland, NJ Health 07068 Stephanie Tamborello 281- 250-2305/973- 325-5395 1200 Hermann Pressler, E-209, Houston, [email protected] Texas 77054 713- 500-9030/713- 500-9068 [email protected]
UNT Health Science Center School of Public Health Erin Carlson Texas Health Steps-DSHS 3500 Camp Bowie Blvd., Fort Worth, Velma Stille Texas 76112 7430 Louis Pasteur Drive, San Antonio, 817- 735-5046/817- 735-2619 Texas 78209 [email protected] 210- 949-2159/210- 949-2047 [email protected] US Army Reserve Physician Recruiting Keith Lehman Texas Public Health Training Center 2001 S. Hanley Road, Suite 540, St. Nancy Crider, MS, RN Louis, MO 63144 1200 Hermann Pressler Drive, Houston, 702- 572-4711/314- 646-8795 Texas 77054 [email protected] 713- 500-9399/713- 500-9397 [email protected] Wyeth Vaccines Clifford S. Pumphrey, Jr. Texas Vaccines for Children Program- 727 Alendale Drive, Coppell, Texas 75019 DSHS 972- 897-0180/972- 393-3364 Alma Chavez, AFIX Consultant [email protected] PO Box 149347, Austin, Texas 78714- 9347
23 Public Health in part by the William Randolph Hearst Foundations Presentations Target Audience: Epidemiologists, healthcare administrators, policy makers, Papers nurses, physicians and other healthcare professionals Intentional Poisoning Exposures Reported to the Texas Poison How need for research project was established: It is expected that improved Control Center, Marcia Becker, MPH, life expectancies and the aging of the US CHES population will present substantial financial and logistic challenges to future Target audience: Educators, Health care healthcare provision. Development of providers, Public Health officials and strategies to reduce the burden on practitioners as well as concerned public healthcare providers and payers is participants. essential to improve quality of life of seniors, control costs and prevent further How the need was established: The need stress on the healthcare system. for research into intentional poisoning was established when it was recognized last Objectives of research: spring that this was an area among Estimate future cancer prevalence intentional injuries/exposures that was Estimate incidence of inpatient increasing rather than decreasing in admissions for infection among annual incidence for Texas. Recent patients with cancer publications confirm national trends as Project future incidence and increasing intentional poisoning cases, economic burden of infection in particularly among female youth 15 to 19 patients with cancer years of age. Texas data indicate that Describe resource utilization and females 20 to 29 years of age have the costs associated with such infections highest rate (7.4/100,000 population) for Examine impact of the aging U.S. intentional poisoning exposures. These population on future hospital are serious events which resulted in 383 admissions for infection in patients deaths from 2000 through 2006 in Texas. with cancer The majority of these exposures were determined to be intentional poisoning for Background: Cancer patients are suspected suicide. particularly susceptible to infections. As cancer prevalence increases due to an Objectives: aging U.S. population (a 73% increase is To determine who is at highest risk of expected by 2025), so will the population intentional poisoning exposures in Texas at risk for infections. To determine what particular substances are involved in the intentional poisonings Methods: From the 2001 Texas discharge in Texas data, we identified all cancer patients’ To gain an understanding of the treatment hospitalizations which had pneumonia, and health outcomes of intentional bacteremia or wound infection as the poisonings in Texas admitting or principal diagnosis. We used To increase awareness of this issue while 2003 Surveillance Epidemiology End addressing healthcare and educational Results (SEER) age-specific cancer resources needed to combat this prevalence estimates and 2006 and 2025 increasing concern. US census population projections to estimate future healthcare system burden Inpatient Admissions for Infection (costs and total hospital bed days utilized) in Cancer Patients: Impact of an due to these infections. We inflated Aging Population, Catherine D. charges to 2006 US$ using Consumer Cooksley DrPH, Elenir B. C. Avritscher Price Index for Medical Care and derived MD, MBA/MHA, Linda S. Elting, DrPH, costs using 2006 Texas Medicare cost-to- Health Services Research Section, charge ratios. Division of Quantitative Sciences, The University of Texas M. D. Anderson Results: Over 18,000 TX inpatients Cancer Center, Houston, Texas, Funded discharged in 2001 had a cancer diagnosis and a potentially preventable
24 infection. Nationally, an estimated total of Abstract: A dashboard is defined as a 318,164 cancer patients were hospitalized graphical user interface that organizes and for infection in 2006 at a cost of $3.1 presents information in a format that is billion (B) (95% CI $2.8B, $3.4B) and easy to read and interpret.1 Dashboards utilizing a total of 2.3 million bed days. Assuming no change but the aging of the have long been used as a tool in business population, projected costs by 2025 could to consolidate financial and performance increase 45% to $4.5B (95% CI $4.1B, reports into a streamlined visual display $4.9) with 27% more (3.4 million) hospital for management. Recently the dashboard bed-days utilized. concept has been modeled in the public Conclusions: Implementing measures health domain. Dashboards have been aimed at preventing serious infections in implemented by state and local health the vulnerable cancer population may reduce healthcare system burdens as the departments to provide access to various population ages and cancer prevalence types and sources of information related to rises. emergency, disaster, and bioterrorism preparedness.2 3 In response to a request Following the Roadmap to from a state health department, we Preparedness Data: Creating a investigated the feasibility of integrating Public Health Preparedness data from various sources into one Dashboard, Catherine Pepper, MLIS, desktop tool. Data collection was MPH, Vipat Kuruchittham, PhD, Robert performed by structured interviews with Lazo, MS, MS, Lisa Tuttle, Rebecca key informants to ascertain their Petrie, MPH, Donald Ward, Sara Thrift, information needs and preparedness data 4 MLIS, Herman Tolentino, MD accessed. In a “parallel design” session, participants drew their own dashboards, Affiliation: Centers for Disease Control and then discussed the components and Prevention, Atlanta, GA 30333; Maine designs they had incorporated. We Center for Disease Control, Augusta, ME, subsequently created a prototype 04330 preparedness dashboard. The presentation illustrates the contribution of 5 Target Audience: Preparedness and public health informatics to what may be syndromic surveillance specialists, data ostensibly perceived as an “IT project,” managers, informaticians, IT specialists, particularly the need to approach such public health administrators, disease projects from a business process and surveillance specialists, epidemiologists, organizational perspective, which requires and others involved and interested in tools the engagement of internal and external for data analysis, visualization, and stakeholders for success. reporting. References Objectives: 1. To identify and document all data elements and processes that Assessment of Evidence-Based relate to preparedness, and Prevention Practices within a create context mapping of Residency-based Family Practice information flow between Center, Linda Hook, RN, Norlynn Ripps, RN, Cathy White, RN, Graduate Students stakeholders via business from the University of the Incarnate Word process analysis. 2. To develop a prototype graphical Target Audience: Public health design for a preparedness practitioners, nurses, and physicians dashboard, including data models (data flow diagrams and Need for Project: Requested by the agency entity-relationship diagrams) of to understand how to make improvements in efficiency and effectiveness based on current component systems. literature regarding the concept of an integrated medical home.
25 Objective: To apply microsystem analysis in accessing the incorporation of Need for Research: Partnership for Prevention™ practices Many Hispanics rely on the health care within a residency based family practice safety net for care. Approximately one- center. third of Hispanics are without health coverage and a growing portion of the Hispanic population are immigrants, Using recommendations from the Institute presenting additional barriers to access of Medicine Crossing the Quality Chasm and care. Community health centers (2001), and the Dartmouth College (CHCs) are an integral part of the safety Assessing Your Practice “The Green net for care to the rapidly growing Book” (2004), the project examined the Hispanic immigrant population. CHCs are coordination of patient care, the consistently mentioned in literature as a management of evidence-based means to improving access to care and knowledge and skills, the presence of health outcomes for Hispanic immigrants multi-disciplinary teamwork, and the and are recognized for their culturally utilization of information technologies at a competent provision of care. However, residency based family practice center. little quantitative evidence is documented reporting the extent to which Hispanic The Center exists as a microsystem within immigrants utilize CHCs and the a larger not-for-profit comprehensive characteristics of the Hispanic immigrants health care system whose mission and who use CHCs. Empirical data is needed core values are directed at respecting the to inform community leaders who seek to dignity of the patients served. The expand access to health care to Hispanic Center’s diverse staff excels in the immigrants about whether a CHC is a fundamental areas of medical practice viable option in serving the needs of the including the use of the electronic medical population it is intended to serve. Results records (EMR). A review of literature calls will inform current policy recommendations to action the need to change the current for CHC expansion as a means to improve primary care paradigm from responding to health care for Hispanic immigrants. episodic, acute, technology-driven activities of medical practice to Research Objective: implementing a holistic, integrated, This research describes the extent to anticipatory-based healthcare system which CHCs are utilized as a regular (Cifuentes et al., 2005; Woolf, et al., 2005; source of care among Hispanic Satcher, Nussbaum, Woolf, & Strange, immigrants compared to Hispanics of U.S. 2006). nativity and other racial and ethnic groups. This study also identifies the demographic Clinical observations and review of 30 characteristics of Hispanic immigrants who patient records revealed opportunities for use CHCs. implementing the Partnership for Prevention™ recommendations. Data Methods: revealed redundant processes in The study analyzes nationally- mandatory immunization reporting, representative 2001 Commonwealth Fund inconsistent and varying proficiencies in Health Care Quality Survey data EMR, and under-developed EMR (n=6,306). Univariate and bivariate templates incorporating Partnership for analyses describe CHC utilization. Prevention™ recommendations. Multivariate analyses model race, ethnicity, and U.S. nativity as predictors of Hispanic Ethnicity and Foreign CHC utilization. Nativity as Predictive Factors of Community Health Center Results: Utilization as a Regular Source of The subgroup of 209 Hispanics who used Care, Erin K. Carlson, M.P.H. and Nuha a CHC as their regular source of care was A. Lackan, Ph.D. , University of North significantly associated with insurance Texas Health Science Center, Fort Worth, status, age, income, poverty threshold, TX and education. Four-fifths reported annual incomes below $35,000. Nearly 62% were Target Audience: Policymakers, uninsured and 68% were under age 40. community stakeholders, and advocates Finally, 70.8% were born outside the U.S. for Hispanic immigrants and/or community health center expansion
26 CHC utilization was greater for foreign- strongly associated with an increase in born Hispanics than other racial/ethnic preventable hospitalizations. However, groups. One-third of foreign-born this significant association diminished as Hispanics reported using a CHC as a the poverty, education, and non-whites regular source of care. Multivariate covariates were added to the model. analyses found that only foreign-born There was not a statistically significant Hispanic and non-Hispanic white were association between the existence of local significant ethnic/racial predictors of CHC safety net clinics and preventable use. Foreign-born Hispanics were more hospitalizations. likely to use CHCs over another care source than any of the other five groups. Cost Drivers of Texas Medicaid Perinatal Care, Jimmy Blanton, MPAff, Conclusions: David Lynch, MA, Judy Devore, PhD, Hispanic immigrants were twice as likely Cheryl Bowcock, MPH, Judy Temple, to use a CHC as a regular care source MSSW, and Gary Rutenberg, PhD compared to another care source. U.S.- born Hispanics, non-Hispanic immigrants, Target audience: Public health and non-Hispanic minorities were not administrators, related professionals significantly associated with CHC. CHCs provide well-utilized care to Hispanic Summary: Since SFY 2000, perinatal immigrants. Policymakers seeking to diagnoses have maintained a stable share increase care for Hispanic immigrants of overall Medicaid spending for inpatient should consider expanding CHC capacity. hospitalization. In SFY 2000, pregnancy and childbirth accounted for 65% of Posters hospitalizations and 43% of expenditures, remaining the same through SFY 2006. Uninsurance, the Local Safety Net However, during this same six year period, and Preventable Medicaid spending for perinatal inpatient Hospitalizations in Harris care increased by about $175 million. An estimated $50 million additional dollars County, Texas, YF Lee and JM were spent for professional fees Swint, University of Texas School associated with these hospital stays. of Public Health, Houston, Texas While this spending growth is proportional (Student Travel Scholarship to increases for other types of inpatient Recipient) care, examination of hospital claims for pregnancy and childbirth shows that In 2004 the Harris County (Texas) almost all of the additional expenditures uninsurance rate was in excess of 30% are due to three specific cost drivers:1) an and 75% of the demand for primary care increase in the number of non-citizen from the safety net population was not residents whose maternal and infant met. Our objective was to examine how health care costs were paid for by the uninsurance rate and local safety net Medicaid, 2) An increase in the rate of may affect access to primary care for newborns delivered via cesarean section, Harris County. The data from this study and 3) An increase in the Medicaid were collected from the Texas Health reimbursement rate for neonates born with Care Information Collection, Census 2000 extreme immaturity or respiratory distress and Project Safety Net. syndrome. The applied methodology was small area Gender and Age Differences in analysis, with ZIP Codes as the unit of analysis. The outcome examined was the Blood Utilization and Length of preventable hospitalization rate for non- Stay in Radical Cystectomy: A elderly adults in the safety net population Population Based Study, Marylou for each ZIP Code. Preventable Cárdenas-Turanzas*, M.D. Dr. P.H., hospitalizations are often used as an Catherine Cooksley, Dr. P.H., Ashish M. indicator of lack of access to care. Patient Kamat, M.D., Curtis A Pettaway, M.D., Quality Indicators, with the exception of Linda S. Elting, Dr. P.H. low birth weight, were used as our inclusion criteria for preventable Names and affiliations of authors: M. hospitalizations in this study. Cárdenas-Turanzas, C. Cooksley and L. Elting. The preliminary results suggest that an Health Services Research, Department of increase in the uninsurance rate was Biostatistics, The University of Texas M.
27 D. Anderson Cancer Center, 1515 – Texas BRFSS, 2007, Rebecca A. Holcombe Blvd. Unit 447, Houston, TX Wood, MSHP; Michelle L. Cook, MPH 77030, USA. Target Audience: Epidemiologists, AM. Kamat and CA. Pettaway researchers, public health Department of Urology, The University of Texas M. D. Anderson Cancer Center, administrators, physicians and other 1515 Holcombe Blvd. Unit1373, Houston, public health professionals interested TX 77030, USA. in HPV vaccination knowledge and attitudes in Texas. *Presenter Background/Need: The first vaccine Purpose: Radical cystectomy is a major to protect against four types of human surgical procedure associated with papillomavirus (HPV) most commonly significant blood loss and lengthy hospital associated with causing cervical stays. This surgical procedure is more challenging in women than men due to cancer was licensed by the Federal anatomical based differences. We Drug Administration in June of 2006. evaluated resource utilization and The Advisory Committee on complication rates of patients undergoing Immunization Practices recommends radical cystectomy or exenteration using the routine vaccination of 11-12 year the Texas Hospital In-patient Discharge old females with three doses of Data Collection. quadrivalent HPV vaccine. Limited data have been collected on the Materials and Methods: Retrospective knowledge and attitudes of men and study of 1493 patients, 35 years of age or older, who underwent radical cystectomy women concerning HPV vaccination for bladder cancer from January 2000 to recommendations. December 2003. We evaluated blood product charges, length of stay, and Objectives: To examine the complication rates during hospitalization. knowledge of and attitudes toward the new HPV vaccine in Texas. Results: In this sample, 24% of the patients (n = 356) were women. Overall, The Heath Resources and Services women had significantly increased blood Administration and Harris County product charges and length of stay Hospital District, Health Care for compared to men, $1392.87 vs. $718.21 (p < 0.001) and 12.72 vs. 11.64 (p = 0.03), the Homeless Program: Working respectively. During hospitalization, 26 of Together to Impact the Plight of the the patients died. No differences in Homeless in Harris County, Princess mortality or complication rates were D. Jackson, MS, Wanda I. De Mello, MBA, observed between men and women. Co-Authors: Kevin Bartlett, RN, MSN, Marion Scott, RN, MSN, Susan Spalding, Multivariate analysis showed that female MD sex (p < 0.001) and age (p = 0.003) were independent predictors of increased blood Target Audience: Health Care for the product charges. Multivariate analysis Homeless Program Administrators, Public showed that female sex (p = 0.015), age Health Officers, Community health (p = 0.003) and Charlson’s comorbidity Centers Administrators, and other Public index > 2 (p = 0.05) were predictors of health Professionals. longer length of stay. Objectives of Project: To identify factors Conclusions: Women and older patients impacting the homeless population ability with bladder cancer are at risk of to access health care services and increased blood products utilization and effective strategies to increase the length of hospital stay after a radical awareness and use of existing health care cystectomy. Future research should focus services for the target population. on improving postoperative outcomes for these vulnerable patients. How need for research of project was established: Health Resources and Human Papillomavirus Vaccine Services Administration (HRSA) Office of Knowledge and Attitudes in Texas Performance Review (OPR) conducts
28 performance reviews to assure performance. In 2007, the Dallas organizations receiving HRSA funds are Regional Division (DRD) OPR conducted successfully accomplishing their programs a performance review with Harris County goals and objectives. In 2007, the Dallas Hospital District – Health Care for the Regional Division of the OPR conducted a Homeless Program (HCHP) to measure performance review with the HCHP to the organization’s impact in providing identify the successes and challenges health care services to the homeless. The faced by the organization in increasing program began operations in 1988 and access to health services to homeless provides preventive and primary care, oral individuals and families in a large health and social and support services to metropolitan area in the United States. In homeless individuals and families. HCHP addition, there is a need to address provides services in eleven health clinics limitations within the service delivery in homeless shelters, two medical mobile system so strategies can be developed to units, one dental unit, and a day center to improve and increase access of health its target population. HCHP reports 100% care service to the homeless. of their clients are below the 200% Federal Poverty Level (FPL). The Abstract: The Health Resources and population served is approximately 52% Services Administration (HRSA), Dallas African-American, 24% White, 13% Regional Division (DRD) Office of Hispanic, and 11% other. Mental Performance Review (OPR) conducted a disorders, hypertension, diabetes mellitus performance review with Harris County and asthma are the most common medical Hospital District – Health Care for the diagnoses seen in the homeless Homeless Program (HCHP) to address population receiving services through the the successes and challenges faced by HCHP. the organization in increasing access to the homeless population in Harris County. One of the measures selected for the A protocol was developed to collect review was the number of unduplicated quantitative and qualitative data to analyze homeless users receiving services through factors that impacted the program’s HCHP over the past four years. This service delivery of healthcare to the performance measure was selected population. The OPR findings indicated because it reflects the grantee’s efforts the following: independently operated and HCHP goal of improving the health shelters’ policies impact the homeless’ status and outcomes for homeless ability to give priority to their medical individuals and families by improving needs, revitalization of the downtown area access to primary health care, mental has forced the homeless to move out and health services, and substance abuse away from traditional service provider treatment. Moreover, the number of networks, and homeless individuals and patients utilizing HCHP services is a families migrating to the city or not living in significant indicator to measure the shelters are unaware of the health care organization’s efforts in meeting services available for them. Given these healthcare needs and impact of services findings, the following strategy was provided to this population. recommended: increase communication and partnerships between shelters, Methodology: The OPR process focuses agencies and government officials to on the selection of performance measures promote the increase of healthcare that reflect the organization’s ability to services through outreach efforts. measure its effectiveness in terms of effort Introduction: and outcome. When measures are chosen, quantitative data is collected The HRSA OPR plays a central role in which will demonstrate the history of the achieving HRSA’s mission by reviewing program’s actual performance and and enhancing the performance of HRSA compare the trend with the grantee’s supported programs within communities projected performance. Qualitative data is and States. The purpose of OPR gathered by a series of telephone and performance reviews is to improve the face-to-face interviews that take place performance of HRSA supported over a 12-week period. Interviews are programs by working collaboratively with semi-structured and designed to support grantees to measure program disclosures to take place in a non- performance, analyze the factors threatening setting. The discussion impacting performance and identify oriented atmosphere is created to build effective strategies to improve trust and elicit honest answers from the
29 participants. The focus of the discussions Objectives: To conduct newborn safe is to identify the restricting factors facing sleep training in 75% of Bexar County HCHP’s ability to increase access to hospital’s Maternal-Child Units. Adoption health care for their target population. A of safe sleep practices in 50% of nurseries root cause analysis is conducted of the that participated in training, witnessed restricting factors so systemic challenges through open crib post intervention can be identified and strategies developed observations. that highlight the benefits of using a community wide approach to confront the Target audience: Newborn nursery, labor issue. Throughout the process, the review and delivery and post-partum staff. team shared all data collected during the interviews with the organization’s Need for Education: Despite a major stakeholders to promote transparency and decrease since 1992 in Sudden Infant trustworthiness. Death Syndrome (SIDS) and the “Back to Sleep” campaign, more than 4,500 infants Findings and Recommendations: The still die suddenly of no obvious cause in performance review process findings our country each year. Bexar County indicated policies of the shelters, which post-neonatal infant mortality rate is about are independently operated, hinder the 150% of the national average. organization’s ability to give priority to the population’s medical needs. Likewise, the Abstract: Studies suggest that instituting revitalization of the downtown Houston new sleep recommendations in the area has caused the homeless to move nursery, as well as in the media that away from traditional service provider surrounds new parents, is likely to networks, which are usually located in discourage parents from using the side metropolitan downtown areas. Lastly, position, propping, and/or swaddling at because of the transient nature of the home (1,2). Maternal-Child hospital staff population, homeless individuals and participated in training discussing (a.) families are not aware of the community’s research-based safe sleep practices, (b.) variety of health care services available to death statistics for the County and (c.) the them. importance of modeling correct positioning of newborns and creating a At the conclusion of the review, the safe sleeping environment during the first following recommendations were 24-48 hours to help educate parents on suggested as methods to increase access the risk factors of SIDS. Surveys of to healthcare services to homeless newborn sleep environment and position individuals and families: First, in the crib were conducted in nurseries increase communication with the shelters that agreed to the intervention. to educate, coordinate services and Observations were conducted in three partner so the collaboration is successful stages: prior to the intervention, midcourse for all stakeholders. Second, host and at the end of project year 1. meetings with the Coalition for the Educational materials for staff and parents Homeless of Houston/Harris County, local were distributed at all hospitals that advisory councils, city officials, police participated in the intervention. departments and associations involved in the improvement of Harris County to Bibliography: expand networking opportunities between Colson ER, Joslin SC. Changing nursery the various local, city and county practice gets inner-city infants in the representatives so outreach activities in supine position for sleep. Arch Pediatr non-traditional service areas can be Adolesc Med. 2002;156:717–720. increased. Third, contact the National Willinger M, Ko CW, Hoffman HJ, Kessler Law Center on Homelessness and RC, Corwin MJ. Factors associated with Poverty. This agency assist caregivers’ choice of infant sleep position, organizations in implementing constructive 1994–1998:the National Infant Sleep alternative solutions to benefit all Position Study. JAMA. 2000;283:2135– stakeholders involved with service delivery 2142. to the homeless population. Keep Infants Sleeping Safely (KISS), Paola Tovar Kurth, MBA & Jann Disparities in Access to Health Rodriguez Carter, RN. Care among Children in the U.S. after SCHIP (1997 to 2005), Alicia C.
30 Guerrero, M.P.H. & Stephanie McFall, 1) Use the Relative Index of Inequality Ph.D. (RII) and the Population Attributable Risk (PAR) to measure income and Target Audience: Disparities researchers, race/ethnicity disparities (respectively) in state and national health policy makers, access to health care among children. child health care advocates. 2) Using the RII and PAR, quantify the change in disparities in health insurance Need for Research: Much of the literature coverage and having a usual source of on disparities in access to health care health care (access to care) after health among children has focused on measuring insurance coverage became available disparities at a single point in time and through the SCHIP. with a focus on race/ethnic groups. This study examines change in income and Abstract: The objective of the research racial/ethnic disparities in access to care was to determine if there was a decrease over time within the child population. The in disparities in access to care for children period of change that will be examined across income and race/ethnicity groups coincides with implementation of major after SCHIP. The study used four years of policy initiatives to enhance access to care data from the National Health Interview for children, the State Children’s Health Survey to depict disparities prior to SCHIP Insurance Program (SCHIP). The Relative (1997-1998) and six years after SCHIP Index of Inequality (RII) and the (2004-2005). Access was measured by Population Attributable Risk (PAR) are two health insurance coverage and having a measures that will be used to quantify the usual source of care. The Relative Index change in disparities. These health of Inequality (RII) and Population inequalities measures use more Attributable Risk (PAR) were used to information about the distribution of the measure and quantify the change in disparities in the population to quantify the disparities. Based on these measures, problem so comparisons aren’t limited to there was a substantial decrease in extreme groups (rich versus poor) or income disparities in both health insurance limited to just two groups (poor versus coverage and having a usual source of non-poor). The RII is a linear regression care following SCHIP. There was also a based estimate and thus can measure the considerable decrease in non-Hispanic access to care differences among ‘rich’ Black disparities in both access to care and ’poor’ income groups while taking into indicators. .However, among Hispanic account the variation that occurs for children there was no change in health income categories between these insurance disparities and a slight increase extremes when plotted appropriately. The in disparities in having a usual source of PAR estimates the proportion of care. While there were great differences in access to care ‘attributable’ improvements in income disparities in to being from a disadvantaged social access to care coinciding with the group. introduction of the SCHIP program, continuing progress in reducing Figure 1. Scatterplot of the percent of race/ethnicity disparities may depend on Children Uninsured by the relative Income continuation of the SCHIP program or group position based on % of Federal similar targeted health coverage Poverty Threshold, 1997-98 vs. 2004-05 programs.
1997-1998 2004-2005 Linear (1997-1998) Linear Hospitals(2004-2005) and Environmental Variation in Texas Nonprofit 30 Hospital Organizational Policies 25 Regarding Charity Care, Mary Kathryn d
e 20 r Martin, “Kate” u s n 15 i Target audience: Safety Net Providers n U 10 % How need for research or education 5 project was established: Approximately 0 25 percent of Texas residents are 0.00 0.20 0.40 0.60 0.80 uninsured.1.00 Nonprofit hospitals are part of Relative SE Grp Position (Income) the safety net for persons who are indigent, low-income and uninsured. Research Objectives Texas was the first state to enact legislation (1993) specifying a percentage
31 of revenues that tax-exempt hospitals support the efforts and collaborations of must dedicate to community benefits. This local public and private nonprofit entities to “quid pro quo” of providing community develop FQHCs. Funds and technical benefits in exchange for tax exemption assistance are provided for clinic start-up, has become controversial. Hospitals use sustainability, federal guideline charity care to determine community compliance, and submittal of federal benefits and meet Texas Health and applications. The FQHC Incubator Safety Code, §311.04610. This paper is Program is vendor contract with a set of the first review of charity care eligibility “deliverables” that parallel the federal policies. program requirements. Deliverables must be completed to the satisfaction of the Objectives of research or education DSHS staff prior to approving project: reimbursement. However, developing, Hospitals designated by state and federal implementing, and measuring a governments as tax-exempt organizations “deliverables” contract program has not enjoy tax relief benefits. Does the charity been without its difficulties. The poster will care provided by nonprofit hospitals equal identify how these specific program the value of the tax exemption? Few requirements, problems/difficulties, etc studies have identified specific nonprofit have developed organizational hospital characteristics or discussed how infrastructure for the delivery of primary these variations in characteristics may care in MUAs. impact policies regarding charity care. Charity care policies are established by Use of Promotores to Improve each nonprofit hospital. This study was Cardiovascular Health of Hispanics undertaken to provide specific information in Fort Worth, Texas, Erin K. Carlson, about the charity care eligibility policies of M.P.H. and Nuha A. Lackan, Ph.D. , nonprofit hospitals. The study examines University of North Texas Health Science hospitals characteristics-by physical Center, Fort Worth, TX location, bed size, disproportionate share, etc and county demographics to determine Target audience: Public health the relationship to charity care eligibility practitioners, providers and others polices. interested in the use of lay health workers to improve health in underserved Beyond Fee-For-Service-Building populations Primary Care Infrastructure Capacity in Texas, Mary Kathryn Need for Research: Evidence suggests Martin, “Kate” that effective prevention strategies engage the community. Such approaches are Target audience: Government Contractors particularly utilized in Hispanic populations and Nonprofit Organizations in response to Hispanics’ strong sense of community. Promotores de salud, Spanish How need for research or education for lay community health workers, offer project was established: One hundred health education to members of Hispanic and seventy-seven counties in Texas are communities and link those they serve federally designated as Medically with health services. Promotores have Underserved Areas (MUA) indicating high been effective at filling gaps in health poverty, infant mortality, inadequate services for medically underserved, socio- provider to patient ratios, etc. MUA economically disadvantaged communities designation is a requirement for health by providing culturally competent care organizations to be designated as education to help individuals prevent the Federally Qualified Health Centers onset of or manage existing diseases. (FQHCs). FQHCs receive federal grants Several studies report the effectiveness of and enhanced reimbursement for chronic disease interventions that employ Medicaid and Medicare patients. The promotores. Health outcomes that have FQHC Incubator Program supports the been improved as a result of promotores development of new and expansion of interventions include self-reported health existing FQHCs addressing access to status, chronic disease primary care in MUAs. FQHCs have management/prevention behaviors, and/or increased from 32 to 59 in five years. health knowledge from pre-test to post- test measures. Objectives of education project: The FQHC Incubator Program is designed to
32 Research Objective: The purpose of this Healthy People 2010 Objectives, as it study was to conduct an educational relates to nutrition and overweight, is “to intervention delivered by Promotores (lay reduce obesity in children to 5 percent.” It Hispanic health workers) who would also is evident that trends in U.S. children serve as case managers to subjects in a mirror a similar increase over the same Hispanic community. The intervention was approximate time period as adults. aimed at improving cardiovascular health However, on a more local level, we utilized (CVH). the Tarrant County Public Health initiative, Monitoring & Assessment Project (M.A.P.) Methods: Individuals attending health report and the 2004 Behavioral Risk fairs whose screening measurements Factor Surveillance System survey report indicated risk for developing to identify both target populations and cardiovascular disease were invited to areas. Two specific factors that were enroll. Subjects were assigned to a considered were: overweight/obesity Promotora for case management. morbidity rates and socioeconomic income Promotores attempted at least monthly levels in Tarrant County. In addition, we contact with study subjects via phone, also reviewed Speaker Bureau Request educational classes or home visits. Forms submitted by external cliental, Educational classes were conducted using paying close attention to subject of the National Institutes of Health National presentation and audience. We also found Heart, Lung and Blood Institute curriculum that a large percentage of requests were for improving CVH. Subjects were invited nutrition and/or physical activity based and to health fairs in January and March for were aimed at elementary/middle school- interim and final measurements. aged children. Screening measures included: total cholesterol, LDL cholesterol, triglycerides, Program Objective: To launch program blood pressure and blood glucose. into four different ISDs and reach 400 5th grade students during the school year Results: Seventy-seven subjects enrolled throughout Tarrant County. in the study. Only 16 (20.7%) subjects attended at least one class, and these Participant Objective: To increase by 30 subjects comprised the intervention group. percent the students’ consumption of fruits The remaining 61 (79.2%) subjects and vegetables and/or physical activity. comprised the control group, and were screened in both September and March. Importance of measuring Over the study period, subjects in the performance to identify key factors intervention group realized reductions in impacting the target population’s fasting blood glucose levels, but did not access to health care and effective have other substantive changes in strategies to improve performance, cardiovascular health indicators. Wanda I. De Mello, MBA and Princess D. Jackson, MS; Co-Author(s): Cynthia L. Garcia, BA, David S. de la Cruz, Ph.D., Conclusions: Using promotores to deliver MPH, Kirk Barnes, MCRP, Llamara Padro- an educational intervention and serve as Milano, BS, Robert Sappington, DMD, case managers can be effective in MPH, Shirley Henley, EdD, ANP reaching Hispanic communities, though subject recruitment and retention must be Target Audience: Maternal and Child emphasized throughout the duration of the Health Program Administrators, Public study. (Source of support: UNTHSC Health Officers, Community Health EXPORT grant) Centers Administrators, Continuous Quality Improvement (CQI) and Public Kids Growing Healthy Program, Health Program Evaluators. Keisha Leatherman, Yvette Jones, Doug Fabio, Dana Tarter How need for research of project was established: Each year, Health Resources Target Audience: 5th Grade Students and Services Administration (HRSA) Office of Performance Review (OPR) Need Statement: The need for a conducts performance reviews to assure nutrition/physical activity program was organizations receiving HRSA funds are established by reviewing various forms of successfully accomplishing their program primary and secondary data and research. goals. The purpose of OPR performance The broad based need indicated in the reviews is to improve the performance of
33 HRSA supported programs by working children living in colonias, public health collaboratively with grantees to select programs should: bring access to the performance review measures, analyze colonias (e.g., mobile units), build and factors that impacted performance in maintain trust in the colonias, increase relation to the selected performance collaboration and partnerships with faith- review measures, identify effective based organizations, provide culturally strategies to improve performance, and and linguistically appropriate health develop an action plan, which includes education for the entire family, promote performance improvement actions to be father involvement, and maintain a high completed by the grantee on each level of promotion of health services performance review measure selected. In available through outreach efforts. 2007, the Dallas Regional Division (DRD) OPR conducted a performance review Background: Each year, Health Resources with Baptist Children’s Home Ministries - and Services Administration (HRSA) Healthy Start Laredo (HSL) Program to Office of Performance Review (OPR) address the successes and challenges conducts performance reviews to assure faced by the organization in increasing that organizations receiving HRSA funds access to health services to women and are successfully accomplishing their their children living in the colonias of program purposes. The purpose of OPR Webb County, Texas. Colonias are rural, performance reviews is to improve the mostly unincorporated communities performance of HRSA supported located in California, Arizona, New programs by working collaboratively with Mexico, and Texas along the U.S.- Mexico grantees to select performance review border and are characterized by high measures, analyze factors that impacted poverty rates and substandard living performance in relation to the selected conditions, such as lack of potable performance review measures, identify drinking water, water and wastewater effective strategies to improve systems, paved streets, and standard performance, and develop an action plan, mortgage financing. which includes performance improvement actions to be completed by the grantee on Objectives of Research: To increase each performance review measure knowledge of the importance of measuring selected. In 2007, the Dallas Regional public health programs performance, Division (DRD) OPR conducted a identify key factors impacting the target performance review with Baptist Children’s population’s access to health care, and Home Ministries - Healthy Start Laredo describe strategies to improve (HSL) Program to address the successes performance. and challenges faced by the organization in increasing access to health services to Abstract: The Health Resources and women and their children living in the Services Administration (HRSA) Office of colonias of Webb County, Texas. Performance Review (OPR) conducted a performance review with Baptist Children’s Methodology: The OPR review team Home Ministries - Healthy Start Laredo (public health analysts and maternal and (HSL) Program to address the successes child health consultant) and Maternal and and challenges faced by the organization Child Health Bureau (MCHB) Project in increasing access to health services to Officer collaborated with the grantee for a women and their children living in the period of twelve weeks to discuss the colonias of Webb County, Texas. The performance review process and select performance review measure selected performance measures for the onsite was “The percentage of HSL women who performance visit and analysis of factors stay in the program 24 months after impacting performance. The performance delivery regardless of birth outcome.” measure “The percentage of HSL women Data analyzed indicated a progressive who stay in the program 24 months after decline in the percent of women who stay delivery regardless of birth outcome” was in the program the complete time. The selected in collaboration with the HSL, research revealed the reasons for the high OPR review team and Healthy Start attrition among HSL women were: status program MCHB project officer. This of parents, transiency of program performance measure was chosen participants, issues related to culture, and because it reflects the MCHB Healthy family priorities and commitments. In Start programs goal of linking mothers and conclusion, to increase access to health infants to a medical home and following services and retain women and their them, at a minimum, from entry into
34 prenatal care through two years after the target population shortly after labor delivery (interconceptional care). HSL data and delivery and before the women and of 117 interconceptional women who children are lost to follow-up care. reported program start and end dates during the period 2005-2007 were used for Risk and Outcomes of Serious the trend analysis. The OPR team visited Postoperative Infections among the grantee for two days and met with all Cancer Patients with Solid Tumors, program staff to discuss performance Elenir B. C. Avritscher, Catherine D. trend, analyze the factors impacting Cooksley, Linda S. Elting performance, and identify strategies to improve performance. Target Audience: Public health community, infections control Results: Of the 117 women, only 6% professionals, oncology researchers and stayed in the program for 24 months after clinicians. delivery. Data indicated a progressive decline in the percent of women who stay How need for research was established: in the program as time progresses; from Cancer patients are at increased risk of 55% retention (0-5 months) to 23% (6-11 infections because of treatment- and/or months), 16% (12-17 months, and 6% (18- disease-related changes in their immune 24 months). Some participant’s factors system. Infections during periods of associated with the short stay in the chemotherapy-induced neutropenia have Healthy Start program described by the being extensively researched, due to its HSL staff and client survey were: status of significant morbidity and mortality. parents (program participants without legal However, postoperative infections among residency constantly fear deportation and non-neutropenic cancer patients remain family separation), transiency of program largely undescribed. Owing to the participants (migration to different frequent surgical treatment of common locations to be closer to family members, solid tumors, there is a large population of obtain basic needs and get away from solid tumor patients at risk for border towns with high police activity, or to postoperative infections. return to Mexico), issues related to culture such as husbands do not allow outsiders Objectives of research: To estimate the to contact their wife nor permit the wife to risk of serious infections and associated discuss personal or health issues, and in-hospital mortality among patients with family priorities and commitments (e.g. common intra-thoracic and intra- school, household duties, medical and abdominal solid tumors undergoing non-medical appointments). surgery at the primary site of their cancers. Conclusion: To increase access to health services and retain women and their ABSTRACT: Background: Postoperative children living in the colonias, public health infections among solid tumor patients programs should: bring access to the remain largely undescribed. We colonias (e.g., mobile units), build and conducted a population-based study of maintain trust in the colonias, increase morbidity and mortality of serious collaboration and partnerships with faith- postoperative infections among patients based organizations providing support and with common intra-thoracic and intra- assistance to the Hispanic population in abdominal solid tumors. the colonias, provide culturally and linguistically appropriate health education Methods: All Texas residents with cancer for the entire family, promote father of the lung, colon, rectum, bladder, involvement, and maintain a high level of pancreas, esophagus, or stomach who promotion of health services available underwent surgeries at the primary site of through outreach efforts. their cancers in Texas between 1/1/1991 and 12/31/2001 were identified from the Implications: Healthy Start programs and Texas Hospital Discharge Database. other public health programs working with Patients who underwent emergency women and children living in colonias procedures were excluded. The billing should evaluate health education records of the eligible pts were examined curriculum and services provided to for ICD-9 codes indicating bacteremia or ensure that a great amount of information septicemia, pneumonia, wound is presented and needed services are abscess/infection. prioritized and provided appropriately to
35 Results: From 1999 to 2001, 17,085 reports in a specific evaluation database. procedures were conducted. Colorectal Baseline data were collected on (52%), and lung (34%) cancers sociodemographics, anthropometrics, predominated. Postoperative infections behavioral, and cognitive variables. A occurred following 1,183 procedures (7%). follow-up data collection was instituted at The risk of postoperative infections varied the end of school years for each of the significantly by primary cancer site; from three years. The Bienestar Program 5% in the colon/rectum to 26% in the comprises 5 components: Health esophagus. Pneumonia alone accounted Curriculum, Physical Education for over half of the infections. Inpatient Curriculum, Family/Community mortality was significantly more common component, Food Service component, and among patients with postoperative an After-School Health Club. infections than those without (19% vs. 2%, p <0.001). Results: Biological measures collected at the beginning and end of third grade were Conclusions: Postoperative infections body mass index (BMI), PBF and FCG. result in significant morbidity and mortality BMI and PBF are indicators of obesity and among patients with common solid tumor FCG is an indicator of diabetes. At the undergoing surgery to treat their primary beginning of third grade, 33% of the cancers. Further study of preventive students were found to be overweight and strategies is warranted. 4% were found to have high blood sugar levels. This is a concern because Proyecto Bienestar Laredo: A nationally only 12% of children in this age translation study of the Bienestar group are overweight. Follow-up data on School-based, diabetes Prevention FCG showed no change between students Health Program, Design and in intervention and control schools after 7 months of intervention. However, to Challenges, RM. Echon. A Bizzari, J. understand the effect of the Bienestar Treviño, V. Castillo, N. Martinez, and R. program implementation level on blood Treviño, The Social & Health Research sugars, intervention schools were divided Center and City of Laredo Department of between schools that implemented the Health programs properly (for 14 weeks) and schools with questionable implementation Background: The Bienestar Health (less than 14 weeks). The program was Program is a bilingual, school-based, designed to be implemented over 20 diabetes prevention program that aims to weeks but not all schools reached that reduce the biological risks for diabetes in level. Students from schools that high-risk Mexican-American children. implemented the program for ≥ 14 weeks Proyecto Bienestar Laredo (PBL) is a showed a decrease in blood sugars (84.54 translation study designed to test the ± 1.55 mg/dl) and students from schools effectiveness of the Bienestar program as that implemented the program for < 14 implemented by local school districts in weeks showed increased in blood sugars Laredo, Texas. The primary aim of the (86.55.188 mg/dl). This was a statistically intervention is to test the study’s significant finding (p < .001). hypothesis that children participating in PBL will have significantly lower fasting Challenges: The Bienestar Health capillary glucose (FCG) and percent body Program’s efficacy trial had shown fat (PBF) than children in schools significant results in reducing FCG, PBF receiving another state-approved health and BMI when implemented with fidelity. curriculum. However, translating the program in a different setting, where school staff is in Design and Methods: PBL is an NIH charge of administering the program, funded, three-year randomized controlled created a new challenge, which is the intervention that targets 3rd-5th grade level of organization within the school Mexican-American students in Laredo, system, as well as the willingness and Texas, with 19 intervention and 19 control competence of the individuals accountable schools. Total number of 3rd grade for its administration. students recruited for the study was 2,376; of which 1,121are males and 1,198 are Discussion: School-based health females. School staffs in the intervention programs can face a number of challenge schools were trained to administer the and obstacles. The current observations Bienestar’s components and were and findings highlight the significance of instructed to log their administration
36 the organizational climate in schools supportable facts from six widely held implementing an innovative program. assumptions about ED utilization.
Hurricane Katrina evacuees in Methods: We analyzed national survey Texas: a comprehensive needs and Texas Medicaid claims data to assessment, Judy Temple, MSSW, investigate ED utilization patterns. Jimmy Blanton, MPAff, David Lynch, MA, and Gary Rutenberg, PhD. Results: An increase in per capita ED Target audience: Public health utilization and a decrease in number of administrators, related professionals hospitals have contributed to the crisis. Purpose: In May 2006, the State of Texas Medicaid/SCHIP clients’ ED utilization for partnered with the Gallup Organization to non-urgent conditions explains part of this survey Katrina evacuees in Texas. As trend. However, they utilize ED services one of the largest needs assessments regardless of urgency at a higher rate than ever conducted on a group of displaced other patients. In Texas, a decline in the U.S. citizens, the survey collected ratio of Medicaid Primary Care Physicians valuable data to assist in the planning of to enrollees may contribute to ED health and human services over upcoming utilization. No consensus details the cost years. differential between treating non-urgent conditions in the ED versus doctor’s office. Methods: Gallup completed telephone HMOs have not restrained ED utilization. interviews with a random sample of 6,415 evacuee households selected from Conclusion: Shifting non-urgent ED FEMA’s emergency relief database. The utilization to another setting is unlikely to survey collected data on housing, produce substantial cost savings but could employment, health, insurance, and social improve quality of care and reduce burden service needs. on EDs.
Results: Eight months after the hurricane, Increase in Congenital Syphilis—Dallas an estimated 251,000 evacuees remained County, 2007, Wendy Chung, MD in Texas. Poor families headed by MSPH1, Jonikquea Houston, MSPH1, African-American women comprised a Marisa Gonzales1, Jeanne Sheffield, disproportionate share of the population. MD2, George Wendel, MD2, Pablo J. Respondents reported high unemployment Sanchez, MD2, John Carlo, MD MSE1 and uninsured rates and declines in (1Dallas County Department of Health and physical and mental health. Despite Human Services, 2University of Texas significant needs, the evacuees’ utilization Southwestern Medical Center) of some state benefits was surprisingly low. Initially, evacuees appear to have Target Audience: Public Health and prioritized necessities, such as shelter. Medical Professionals While this strategy stabilized their living conditions, the survey results will help Background/Need for Project: Congenital target the evacuees’ longer-term syphilis (CS) is a consequence of economic and healthcare needs. inadequately treated maternal syphilis during pregnancy. Rates of congenital Examining conventional syphilis closely follow the incidence of assumptions of emergency early syphilis in women of reproductive department utilization: Texas and age. Following the greater numbers of nationwide, Jimmy Blanton, MPAff, women reported with early syphilis in David Lynch, MA, Judy Temple, MSSW, 2006, Dallas County has experienced an Gary Rutenberg, PhD. increase in CS cases in 2007.
Target audience: Public health Objectives: To investigate the administrators, related professionals epidemiology of CS cases in Dallas County in order to identify opportunities for Purpose: Emergency Departments (ED) prevention. have entered a crisis period characterized by overcrowding, patient boarding, and Methods: Infants meeting CDC case ambulance diversion raising concerns definition for CS were identified through about patient safety and rising healthcare Dallas County Department of Health and costs. This paper distinguishes Human Services surveillance records from 2005 through October 2007. Medical
37 records of these infants born in 2007 and ABSTRACT: To characterize temperature their mothers were reviewed. changes in Texas during the past three decades, NCDC records of average Results: Cases of early syphilis among monthly temperatures were analyzed with women in Dallas County increased from a STATA logistic regression. Nine sites 44 in 2005 to 78 in 2006. From January were used for the time series analysis: through October 2007, 19 cases of CS Houston IAH, Angleton, Conroe, Brenham, have been reported, compared to10 total San Marcos, San Antonio, Austin, cases in 2006. Of the 19 mothers, the Fredericksburg, and Del Rio. Warming mean age was 25 years; 17 (90%) were over the past three decades was observed black; one had HIV infection, and 2 had for most sites, but was not statistically cocaine-use during pregnancy. Eight significant, nor was it of similar magnitude mothers had previously non-reactive RPR or direction when full years were tests within one year prior to delivery. In 8 compared. Data were also analyzed by cases (42%), the mother received no coldest month, warmest month, three prenatal care or initiated care late in the coldest months, three warmest months third trimester. Of the 11 mothers who and season. Seasonal analysis produced entered care by 28 weeks gestation, strong characterizations of changing syphilis screening at 28 weeks gestation temperature and indicated increasing may have prevented 5 cases. temperatures for all nine sites. Winter month temperatures (January, February, Conclusions: Timely antenatal screening and March) for all sites except Del Rio and treatment of mothers is essential in followed an ascending wedge distribution the control of congenital syphilis. Lack of and increased 0.13 to 0.18 °F per year for prenatal care and failure to screen the six easternmost sites (p < 0.05). pregnant women in the third trimester Summer month temperatures were also were factors in 68% of current CS cases in increasingly warmer and better Dallas and remain important contributors characterized when analyzed by summer to congenital syphilis. season months (July, August and Using seasonal average temperatures September). The changes ranged from to characterize warming winter trends: 0.07 to 0.09 °F increased temperature per nine selected sites in Texas, 1970 to year for eight sites with a maximum 2000, Roslyn M. Dupré, Keith Burau, and change of 0.15 °F in Del Rio. Irina Cech “Cheese” Drug (Heroin) Related Deaths TARGET AUDIENCE: Environmental in Students—Dallas County 2004-2007, Health and Calvin White, MPH, Melicia R. Brown, Infectious Disease Epidemiology MPH, John Carlo, MD, MSE, Dallas professionals County Health and Human Services, and students. Jeffrey Barnard, MD, Dallas County Medical Examiner’s Office BACKGROUND: In 2003, the World Health Organization called for researchers BACKGROUND: Heroin is the least used to establish baseline relationships illegal substance by students, but remains between weather and health in response one of the most common drugs causing to reported global warming temperature overdose and death in children under the trends [1]. As a project for UTSPH course age of 18 in Dallas County. A drug with a Medical Geography (Instructors: Drs. Irina new name “cheese” has been reportedly Cech, Keith Burau and Michael used by school-age children since 2005. Smolensky), National Climatic Data “Cheese” or “starter heroin” is a Center (NCDC) records for 9 cities in combination of heroin and crushed cold Texas approximately along latitude 30° N medicine (Tylenol PM) containing and between longitudes 95.35° and acetaminophen and diphenhydramine. 100.91° W . METHODS: A retrospective review of the OBJECTIVE: To improve the County Medical Examiners’ Database for characterization of changes in Dallas County residents under the age of temperature in central Texas from 1970 to 18 with toxic effects of heroin listed as 2000 by NCDC average monthly cause of death was conducted for the temperature data. period of January 2004- April 2007.
38 RESULTS: There were a total of 23 deaths during this time period. Cases Innovative materials were developed to were disproportionately higher in males improve the practice of public health in (80%) than females (20%). Toxicology three areas. First, a high volume of testing demonstrated a high percentage of persons with exposure to active TB and cases with poly substance abuse. populations with elevated risk factors need evaluation. Clinician time is limited; CONCLUSIONS: Compared to prior priority must be placed on TB suspects years Dallas County has experienced an and cases. Clinical templates were increase in deaths due to targeted efforts developed to improve efficiencies in to increase heroin use among school-age evaluation of TB contacts and high-risk children. populations.
Second, pediatric TB cases (<12 years of Educational Materials age) are usually not contagious and the TB investigation focuses on finding the Innovations in Public Health source case that transmitted TB to the Practice in a Tuberculosis (TB) child. The DSHS tool for TB investigations Control and Prevention Program, does not easily apply to this situation. A John Nava, MD, Cara Hausler, BS, new interview worksheet was developed Edwardo Dominguez, San Antonio to more specifically focus on the child’s Metropolitan Health District, TB Control & home, school and play environments, Prevention Program improving source case identification. Third, TB patients, contacts and members Target Audience: Public health of the community have difficulty practitioners, physicians, patients and the understanding the differences between public latent TB infection and active TB disease. An English and Spanish educational tool Objective: To improve three areas of was developed to clarify these differences. public health practice within a TB program at a local health department: 1) to improve The presentation will highlight these efficiencies in clinician evaluation of TB innovations. Staff will be available to contacts and high-risk populations, 2) to discuss them and provide resources for improve identification of the sources of TB use by others. In a recent DSHS review, exposure in newly diagnosed pediatric TB the reviewers were impressed with the cases or suspects and 3) to improve clinical templates and suggested they be understanding of the difference between shared throughout the state. latent TB infection and active TB disease by TB patients and the public.
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