- Email: [email protected]
The Influence of Surgical Subspecialty Training on In-Hospital Mortality for Cancer Procedures
Abstracts / Annals of Epidemiology 23 (2013) 581e598
only increased for non-asthmatics on lag day 2: RR¼1.003 (1.000-1.005). Risks for other pollutants often appeared higher for asthmatics but were less consistent. Conclusion: Asthmatics may be more susceptible to acute exposure to traffic-related pollutants, such as NOx and CO, which could trigger PTB.
P34-S. Impact of Aerial Insecticide Spraying on West Nile Virus Disease d North Texas, 2012 D. Ruktanonchai, S. Pillai, S. Stonecipher, N. Lindsey, K. Horiuchi, M. Delorey, B. Biggerstaff, T. Sidwa, J. Zoretic, J. McAllister, R. Nasci, M. Fischer, S. Hills. TX DSHS, Austin, TX Purpose: West Nile virus (WNV) is the leading cause of mosquitoborne disease in the United States. During 2012, four north Texas counties reported >840 WNV cases, six times more than any previous year. In response, larviciding and ground-based adulticide spraying were performed variably throughout the area and, for the first time in north Texas, aerial insecticide spraying was used for WNV control with two counties treated in August. We evaluated aerial spraying's impact on WNV disease. Methods: We defined a case as a resident of one of the four counties who, in 2012, had laboratory-confirmed WNV neuroinvasive disease using the national surveillance case definition. Patients were categorized as living within or outside the aerial-sprayed area. We calculated incidence rate ratios (IRRs) in treated and untreated areas by comparing incidence rates before and after spraying; for unsprayed areas, before and after periods were defined by using spray dates from a corresponding sprayed area. We evaluated aerial spraying's impact by using the ratio and 95% confidence intervals (CIs) of IRRs in treated and untreated areas. Results: In treated areas, the incidence before and after spraying was 7.47 and 0.28 per 100,000 persons, respectively; the IRR was 27.00 (95% CI: 12.70e57.41). In untreated areas, the before and after incidence was 4.80 and 0.45 per 100,000 persons, respectively; the IRR was 10.57 (95% CI: 6.11e18.29). The ratio of these IRRs was 2.55 (95% CI: 1.01e6.49). Conclusion: WNV neuroinvasive disease incidence decreased in the afterspray period in both areas, but the relative change was significantly greater in aerial-sprayed areas.
P35. Associations Between Environmental Characteristics and Weight Status in Elementary School Children R.R. Suminski, J.A. Wasserman, C.A. Mayfield, L.W. Segars, A. Glaros. Kansas City University of Medicine and Biosciences, Kansas City, MO Purpose: In this cross-sectional study we examined associations between food outlets and physical activity facilities and body mass index percentile rankings (BMIp). Methods: Trained investigators visited 43 elementary schools to collect data on a sample (n¼6,939) of Hispanic (36.7%), Black (39.8%), and White (23.5%) boys (51.7%) and girls (mean age ¼ 8.3 y; mean BMIp ¼ 71.3) living in the zip code areas of the schools (i.e., school neighborhoods). In addition, information about the number of convenience, fast food, and grocery stores and park, playground, and fitness facilities in the school neighborhoods was obtained using various search methods (e.g., Internet, in-person audits). Results: Hispanic had significantly higher BMIp than Whites and Blacks. The multi-level regression analyses adjusted for school neighborhood (crime rate) and school (percent free/reduced lunch, PE offered) characteristics, indicated that higher BMIp were associated with fewer parks (Hispanic girls) and fitness facilities (Black boys) and more fast food stores (White and Hispanic boys) (p<0.05). Conclusion: Environmental characteristics of the neighborhoods surrounding elementary schools are associated with the weight status of children attending and living near those schools. The associations vary according to the racial/ethnic background and gender of the child.
P36. Cumulative Neighborhood Risk and Allostatic Load in Adolescents K.P. Theall, E.A. Shirtcliff, S.S. Drury. Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA
589
Purpose: We examine the impact of cumulative neighborhood risk on AL among adolescents as a mechanism through which life stress, including neighborhood conditions, may impact health and health inequities. Methods: Multilevel analyses were conducted, weighted for sampling and propensity score matched, among 12-20 year-old adolescents in the NHANES, 1999-2006 (first level, n¼11,886) nested within family/household (second level, n¼6,696) and census tracts (third level, n¼2,191) to examine the contextual effect of cumulative neighborhood risk environment on AL. Results: Approximately 35% of adolescents had 2 or more biomarkers of AL. A significant amount of variance in AL was explained at the neighborhood level. Even after taking into account household and other individual factors, the likelihood of having a high AL was approximately 10% higher for those living in medium cumulative risk (adjusted OR ¼ 1.09, 95% CI ¼ 1.08, 1.09), 30% higher those living in high (adjusted OR ¼ 1.28, 95% CI ¼ 1.27, 1.30), and 69% higher for those living in very high risk neighborhoods (adjusted OR ¼ 1.69, 95% CI ¼ 1.68, 1.70) compared to those in low risk areas. Conclusion: These findings offer support for the hypothesis that neighborhood risks may culminate in a range of biologically-mediated negative health outcomes detectable in adolescents.
Health Services P37-S. Ethnicity, Gender, Need for Mental Health Care and Inpatient Mental Health Care Utilization Among American Blacks Shervin Assari MD, MPH. University of Michigan School of Public Health Purpose: To determine the effect of gender on the effect of having a definite need for mental health care on use of inpatient mental health services among a community sample of African Americans and Caribbean Blacks in the United States. Methods: Data came from National Survey of American Life, a national representative data of noninstitutionalized African Americans (n¼3,123) and Caribbean Blacks (n¼1,319). Presence of lifetime psychiatric disorder was independent variable, determined by a modified version of the Composite International Diagnostic Interview. Dependent variable was lifetime inpatient mental health care use. We tested main effects of gender and lifetime psychiatric disorder and their interactions in logistic regressions specific for each ethnic group. We also tested main effect and interactions of ethnicity, gender and any lifetime psychiatric disorder in the pooled sample. Results: Among African Americans (OR¼3.303; 95% CI ¼ 1.015 to 10.753), but not Caribbean Blacks (OR¼0.342; 95% CI¼0.009 to 12.488), male gender increased the odds of inpatient mental health care utilization associated with any lifetime psychiatric disorder. Based on our pooled regression model, the effect of male gender on inpatient mental health care use was larger for African Americans than Caribbean Blacks (OR for interaction term¼ 4.5, 95% CI ¼ 1.3 to 15.8). Conclusion: Among African Americans with serious mental health need, male gender is associated with 3.3 times higher odds of inpatient mental health care use. This gender disparity does not exist among Caribbean Blacks.
P38. The Influence of Surgical Subspecialty Training on InHospital Mortality for Cancer Procedures P. Christos, M. Mazumdar, A. Mushlin. Department of Public Health, Weill Cornell Medical College, New York, NY Purpose: Patients operated on by surgeons with specialty training have been shown to have lower mortality rates. The objective of this study was to evaluate the independent effect of surgical subspecialty training (training) on in-hospital mortality for cancer patients undergoing colectomy or gastrectomy surgical procedures. Methods: We studied all colectomy and gastrectomy (N¼62,719) discharges for cancer from the New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) database during 1998 to 2006. Training was defined as membership in the Society of Colorectal Surgery or the Society of Surgical Oncology. In-hospital mortality rates were compared for patients operated on by surgeons with and without training, adjusted for patient characteristics, surgeon volume, and hospital volume. Clustering by surgeon was explored with both generalized estimating equations (GEE) and random effects (RE) modeling.
590
Abstracts / Annals of Epidemiology 23 (2013) 581e598
Results: GEE and RE models revealed modest protective effects of training on in-hospital mortality for colectomy (OR¼0.79, 95% CI ¼ 0.61- 1.02), but not gastrectomy (OR¼0.88, 95% CI ¼ 0.63-1.22). However, protective effects were more pronounced for high-volume surgeons in highvolume hospitals (vs. low surgeon/hospital volume) (colectomy: OR¼0.55, 95% CI ¼ 0.47-0.65; gastrectomy: OR¼0.46, 95% CI ¼ 0.34-.61). Conclusion: Training appears to be less important than surgeon and hospital volume. These findings may have implications for surgical training programs and for regionalization of complex surgical procedures.
P39. Availability of Vaccines for Children Providers in Texas: A County-Level Analysis J.M. Eberth, J. Hibbert. University of South Carolina, Columbia, SC Purpose: The Vaccines for Children (VFC) program provides vaccines recommended through the Advisory Committee on Immunization Practices free of charge to children who are aged 0-18 and Medicaid-eligible, un/underinsured, or AI/AN. Ensuring equitable access to these services is a public health priority. The purpose of our study was to examine the availability of VFC providers in Texas from a spatial perspective. Methods: We obtained data on the locations of all VFC-registered providers in Texas from the TX Department of State Health Services Immunization Branch and the San Antonio Metropolitan Health District in April 2011. Using ArcGIS V10.1, we mapped the locations of all the VFCregistered providers and summarized the results at the county-level. Results: Eighteen counties, mostly in the West or Northwestern part of the state, did not have a registered VFC provider. Several of these counties were spatially contiguous, representing a substantial shortage of the vaccine safety-net for portions of Texas. The range of VFC providers per county was 0549 (Mean ¼ 15, Median ¼ 5). Conclusion: Our preliminary work indicates several pockets of low availability of VFC providers in West and Northwestern Texas, but adequate availability on the whole. Future work will address the spatial accessibility of these VFC providers, accounting for both the supply and potential demand for services.
P40. Propensity to Succeed: A New Method to Target and Outreach to Members Most Likely to Benefit From A High Risk Case Management Program Kevin Hawkins PhD, Ronald J. Ozminkowski PhD, Asif Mujahid MBA, Timothy S. Wells PhD, Gandhi R. Bhattarai PhD, Shaohung S. Wang PhD, Cynthia E. Hommer MSW, LICSW, Jinghua Huang PhD, Richard J. Migliori MD, Charlotte S. Yeh MD. Purpose: Most high risk case management (HRCM) programs target patients with prolonged illnesses, multiple diseases or in the final stages of life. However, they are often difficult to manage and engage while attempting to improve their overall health status. Methods: A predictive model was developed to identify demographic, socioeconomic and health status characteristics associated with the likelihood to engage, receive quality-related care and to bend the cost curve. The propensity to succeed score was comprised by combining the three likelihood scores for each eligible member. This score was then used to prioritize engagement and outreach efforts in the program. Results: Several characteristics were predictive of engagement, quality related care and bending the cost curve resulting in a wide range of propensity to succeed scores that made for easy prioritization of new eligible members. Conclusion: Using these models should increase program engagement, quality of care, and financial success of this program.
P41. Do Asians Demonstate Optimal Compliance In CDC Recommended Pediatric Vaccine Schedule? K. Dabney, P. Oceanic, D. Fitzgerald, K. Grant, L. Holmes Jr. Office of Health Equity & Inclusion, Nemours Children Hospital, Wilmington, DE
Purpose: We aimed to assess the prevalence of vaccination schedule by race/ ethnicity, and to determine whether or not Asians demonstrate optimal compliance. Methods: We assessed data cross-sectionally on vaccination received during 2010. Chi squared statistic and multivariable logistic regression model were used. Results: Recipients were Whites/Caucasians, 1,917(32.7%), Blacks/African Americans (AA), 2904(49.5%), Asian, 134(2.3%), Hawaiian native/Pacific Islander,4(0.1%), American Indian/Alaskan Native(AI/AN),9(0.2%), and some other race, 727(12.4%). There was overall 92.3% compliance to the recommended schedule. A significant racial variability in MMR as well as HBV were observed, Asian (98.5%), AA (98.4%) and Caucasian (97.1%), c2(7)¼20.6, p¼0.01, and Asians (99.3%), AA(94%) and Caucasian (98.7%), c2(7)¼23.9, p¼0.001 respectively. Asians demonstrated highest compliance in the receipt of varicella (Asians [99.3%], AA [98.6%], and Caucasian [97.1%], c2(7)¼18.7, p¼0.01, and toxoid poliovirus (Asians[100%], AA[99.4%] and Caucasian [99%], c2(7)¼12.3, p¼0.09. Asians (97.0%) relative to AA (93.1%) and Caucasian(91%) demonstrated the highest compliance in all vaccines combined, c2(7)¼24.5, p¼0.001. Caucasians and AA, relative to Asians were 69% (Odds ratio [OR]¼ 0.42, 95% CI, 0.15-1.14, and 58%, (OR¼0.31, 95%CI, 0.11-0.85) less likely to adhere to the CDC schedule respectively. after controlling for insurance status, the significant racial disparities did not persist between Asians and Caucasians, adjusted OR, 0.45, 99%CI,0.08-1.11. Conclusion: Asians demonstrated highest compliance, indicative of racial/ ethnic disparities.
P42. CDC'S First National Tobacco Education Campaign's Impact on Quitline Caller's Intermediate Cessation Outcomes A. Malarcher, L. Zhang, K. Vickerman, P. Mowery. Office on Smoking and Health, CDC, Atlanta, Georgia; Alere Wellbeing, Seattle, Washington Purpose: To educate the public on the immediate health damage caused by smoking and to encourage smokers to quit, the Centers for Disease Control and Prevention launched the first federally-funded National Tobacco Education Media Campaign e Tips From Former Smokers (TIPS) e for 3 months in 2012. This study examined the Campaign's impact on callers’ quit attempts and on cessation. Methods: Using 22 states and DC's quitline data, we compared the number of callers and callers who received services during the 2012 TIPS campaign to the previous year. Using multivariate logistic regression controlling for confounding factors, we examined the relationship between TIPS exposure (gross rating points) and 24 hour quit attempts or 7+ day cessation during treatment. Results: The number of unique quitline callers and callers who received counseling or NRT increased 88.6% and 70.8%, respectively during the TIPS campaign compared to similar weeks in 2011. Greater numbers of callers reported positive intermediate cessation outcomes during the TIPS campaign; although proportionally fewer engaged in these behaviors compared to the previous year. Higher TIPS campaign exposure was positively associated with intermediate cessation outcomes among persons from states with higher tobacco control funding. Conclusion: An evidence-based national tobacco education campaign with adequate reach and frequency can lead to substantial increases in quitline use and intermediate cessation outcomes.
P43. Differences in Blood Ambulatory Care Settings
Pressure
Measurement
in
W.S. Pearson, R. Merritt. Office of Prevention through Healthcare, Centers for Disease Control and Prevention, Atlanta, GA Purpose: Blood pressure (BP) monitoring is an important tool in preventing both morbidity and mortality from heart disease. Each point of contact with the healthcare system provides this opportunity. This study compared numbers of visits where BP was measured at the time of the visit for different ambulatory care settings. Methods: Data were taken from three years (2008-2010) of the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to produce estimates of the numbers of visits to both community-based physician offices and hospital-based outpatient departments that performed a BP measurement at the time of visit.
only increased for non-asthmatics on lag day 2: RR¼1.003 (1.000-1.005). Risks for other pollutants often appeared higher for asthmatics but were less consistent. Conclusion: Asthmatics may be more susceptible to acute exposure to traffic-related pollutants, such as NOx and CO, which could trigger PTB.
P34-S. Impact of Aerial Insecticide Spraying on West Nile Virus Disease d North Texas, 2012 D. Ruktanonchai, S. Pillai, S. Stonecipher, N. Lindsey, K. Horiuchi, M. Delorey, B. Biggerstaff, T. Sidwa, J. Zoretic, J. McAllister, R. Nasci, M. Fischer, S. Hills. TX DSHS, Austin, TX Purpose: West Nile virus (WNV) is the leading cause of mosquitoborne disease in the United States. During 2012, four north Texas counties reported >840 WNV cases, six times more than any previous year. In response, larviciding and ground-based adulticide spraying were performed variably throughout the area and, for the first time in north Texas, aerial insecticide spraying was used for WNV control with two counties treated in August. We evaluated aerial spraying's impact on WNV disease. Methods: We defined a case as a resident of one of the four counties who, in 2012, had laboratory-confirmed WNV neuroinvasive disease using the national surveillance case definition. Patients were categorized as living within or outside the aerial-sprayed area. We calculated incidence rate ratios (IRRs) in treated and untreated areas by comparing incidence rates before and after spraying; for unsprayed areas, before and after periods were defined by using spray dates from a corresponding sprayed area. We evaluated aerial spraying's impact by using the ratio and 95% confidence intervals (CIs) of IRRs in treated and untreated areas. Results: In treated areas, the incidence before and after spraying was 7.47 and 0.28 per 100,000 persons, respectively; the IRR was 27.00 (95% CI: 12.70e57.41). In untreated areas, the before and after incidence was 4.80 and 0.45 per 100,000 persons, respectively; the IRR was 10.57 (95% CI: 6.11e18.29). The ratio of these IRRs was 2.55 (95% CI: 1.01e6.49). Conclusion: WNV neuroinvasive disease incidence decreased in the afterspray period in both areas, but the relative change was significantly greater in aerial-sprayed areas.
P35. Associations Between Environmental Characteristics and Weight Status in Elementary School Children R.R. Suminski, J.A. Wasserman, C.A. Mayfield, L.W. Segars, A. Glaros. Kansas City University of Medicine and Biosciences, Kansas City, MO Purpose: In this cross-sectional study we examined associations between food outlets and physical activity facilities and body mass index percentile rankings (BMIp). Methods: Trained investigators visited 43 elementary schools to collect data on a sample (n¼6,939) of Hispanic (36.7%), Black (39.8%), and White (23.5%) boys (51.7%) and girls (mean age ¼ 8.3 y; mean BMIp ¼ 71.3) living in the zip code areas of the schools (i.e., school neighborhoods). In addition, information about the number of convenience, fast food, and grocery stores and park, playground, and fitness facilities in the school neighborhoods was obtained using various search methods (e.g., Internet, in-person audits). Results: Hispanic had significantly higher BMIp than Whites and Blacks. The multi-level regression analyses adjusted for school neighborhood (crime rate) and school (percent free/reduced lunch, PE offered) characteristics, indicated that higher BMIp were associated with fewer parks (Hispanic girls) and fitness facilities (Black boys) and more fast food stores (White and Hispanic boys) (p<0.05). Conclusion: Environmental characteristics of the neighborhoods surrounding elementary schools are associated with the weight status of children attending and living near those schools. The associations vary according to the racial/ethnic background and gender of the child.
P36. Cumulative Neighborhood Risk and Allostatic Load in Adolescents K.P. Theall, E.A. Shirtcliff, S.S. Drury. Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA
589
Purpose: We examine the impact of cumulative neighborhood risk on AL among adolescents as a mechanism through which life stress, including neighborhood conditions, may impact health and health inequities. Methods: Multilevel analyses were conducted, weighted for sampling and propensity score matched, among 12-20 year-old adolescents in the NHANES, 1999-2006 (first level, n¼11,886) nested within family/household (second level, n¼6,696) and census tracts (third level, n¼2,191) to examine the contextual effect of cumulative neighborhood risk environment on AL. Results: Approximately 35% of adolescents had 2 or more biomarkers of AL. A significant amount of variance in AL was explained at the neighborhood level. Even after taking into account household and other individual factors, the likelihood of having a high AL was approximately 10% higher for those living in medium cumulative risk (adjusted OR ¼ 1.09, 95% CI ¼ 1.08, 1.09), 30% higher those living in high (adjusted OR ¼ 1.28, 95% CI ¼ 1.27, 1.30), and 69% higher for those living in very high risk neighborhoods (adjusted OR ¼ 1.69, 95% CI ¼ 1.68, 1.70) compared to those in low risk areas. Conclusion: These findings offer support for the hypothesis that neighborhood risks may culminate in a range of biologically-mediated negative health outcomes detectable in adolescents.
Health Services P37-S. Ethnicity, Gender, Need for Mental Health Care and Inpatient Mental Health Care Utilization Among American Blacks Shervin Assari MD, MPH. University of Michigan School of Public Health Purpose: To determine the effect of gender on the effect of having a definite need for mental health care on use of inpatient mental health services among a community sample of African Americans and Caribbean Blacks in the United States. Methods: Data came from National Survey of American Life, a national representative data of noninstitutionalized African Americans (n¼3,123) and Caribbean Blacks (n¼1,319). Presence of lifetime psychiatric disorder was independent variable, determined by a modified version of the Composite International Diagnostic Interview. Dependent variable was lifetime inpatient mental health care use. We tested main effects of gender and lifetime psychiatric disorder and their interactions in logistic regressions specific for each ethnic group. We also tested main effect and interactions of ethnicity, gender and any lifetime psychiatric disorder in the pooled sample. Results: Among African Americans (OR¼3.303; 95% CI ¼ 1.015 to 10.753), but not Caribbean Blacks (OR¼0.342; 95% CI¼0.009 to 12.488), male gender increased the odds of inpatient mental health care utilization associated with any lifetime psychiatric disorder. Based on our pooled regression model, the effect of male gender on inpatient mental health care use was larger for African Americans than Caribbean Blacks (OR for interaction term¼ 4.5, 95% CI ¼ 1.3 to 15.8). Conclusion: Among African Americans with serious mental health need, male gender is associated with 3.3 times higher odds of inpatient mental health care use. This gender disparity does not exist among Caribbean Blacks.
P38. The Influence of Surgical Subspecialty Training on InHospital Mortality for Cancer Procedures P. Christos, M. Mazumdar, A. Mushlin. Department of Public Health, Weill Cornell Medical College, New York, NY Purpose: Patients operated on by surgeons with specialty training have been shown to have lower mortality rates. The objective of this study was to evaluate the independent effect of surgical subspecialty training (training) on in-hospital mortality for cancer patients undergoing colectomy or gastrectomy surgical procedures. Methods: We studied all colectomy and gastrectomy (N¼62,719) discharges for cancer from the New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) database during 1998 to 2006. Training was defined as membership in the Society of Colorectal Surgery or the Society of Surgical Oncology. In-hospital mortality rates were compared for patients operated on by surgeons with and without training, adjusted for patient characteristics, surgeon volume, and hospital volume. Clustering by surgeon was explored with both generalized estimating equations (GEE) and random effects (RE) modeling.
590
Abstracts / Annals of Epidemiology 23 (2013) 581e598
Results: GEE and RE models revealed modest protective effects of training on in-hospital mortality for colectomy (OR¼0.79, 95% CI ¼ 0.61- 1.02), but not gastrectomy (OR¼0.88, 95% CI ¼ 0.63-1.22). However, protective effects were more pronounced for high-volume surgeons in highvolume hospitals (vs. low surgeon/hospital volume) (colectomy: OR¼0.55, 95% CI ¼ 0.47-0.65; gastrectomy: OR¼0.46, 95% CI ¼ 0.34-.61). Conclusion: Training appears to be less important than surgeon and hospital volume. These findings may have implications for surgical training programs and for regionalization of complex surgical procedures.
P39. Availability of Vaccines for Children Providers in Texas: A County-Level Analysis J.M. Eberth, J. Hibbert. University of South Carolina, Columbia, SC Purpose: The Vaccines for Children (VFC) program provides vaccines recommended through the Advisory Committee on Immunization Practices free of charge to children who are aged 0-18 and Medicaid-eligible, un/underinsured, or AI/AN. Ensuring equitable access to these services is a public health priority. The purpose of our study was to examine the availability of VFC providers in Texas from a spatial perspective. Methods: We obtained data on the locations of all VFC-registered providers in Texas from the TX Department of State Health Services Immunization Branch and the San Antonio Metropolitan Health District in April 2011. Using ArcGIS V10.1, we mapped the locations of all the VFCregistered providers and summarized the results at the county-level. Results: Eighteen counties, mostly in the West or Northwestern part of the state, did not have a registered VFC provider. Several of these counties were spatially contiguous, representing a substantial shortage of the vaccine safety-net for portions of Texas. The range of VFC providers per county was 0549 (Mean ¼ 15, Median ¼ 5). Conclusion: Our preliminary work indicates several pockets of low availability of VFC providers in West and Northwestern Texas, but adequate availability on the whole. Future work will address the spatial accessibility of these VFC providers, accounting for both the supply and potential demand for services.
P40. Propensity to Succeed: A New Method to Target and Outreach to Members Most Likely to Benefit From A High Risk Case Management Program Kevin Hawkins PhD, Ronald J. Ozminkowski PhD, Asif Mujahid MBA, Timothy S. Wells PhD, Gandhi R. Bhattarai PhD, Shaohung S. Wang PhD, Cynthia E. Hommer MSW, LICSW, Jinghua Huang PhD, Richard J. Migliori MD, Charlotte S. Yeh MD. Purpose: Most high risk case management (HRCM) programs target patients with prolonged illnesses, multiple diseases or in the final stages of life. However, they are often difficult to manage and engage while attempting to improve their overall health status. Methods: A predictive model was developed to identify demographic, socioeconomic and health status characteristics associated with the likelihood to engage, receive quality-related care and to bend the cost curve. The propensity to succeed score was comprised by combining the three likelihood scores for each eligible member. This score was then used to prioritize engagement and outreach efforts in the program. Results: Several characteristics were predictive of engagement, quality related care and bending the cost curve resulting in a wide range of propensity to succeed scores that made for easy prioritization of new eligible members. Conclusion: Using these models should increase program engagement, quality of care, and financial success of this program.
P41. Do Asians Demonstate Optimal Compliance In CDC Recommended Pediatric Vaccine Schedule? K. Dabney, P. Oceanic, D. Fitzgerald, K. Grant, L. Holmes Jr. Office of Health Equity & Inclusion, Nemours Children Hospital, Wilmington, DE
Purpose: We aimed to assess the prevalence of vaccination schedule by race/ ethnicity, and to determine whether or not Asians demonstrate optimal compliance. Methods: We assessed data cross-sectionally on vaccination received during 2010. Chi squared statistic and multivariable logistic regression model were used. Results: Recipients were Whites/Caucasians, 1,917(32.7%), Blacks/African Americans (AA), 2904(49.5%), Asian, 134(2.3%), Hawaiian native/Pacific Islander,4(0.1%), American Indian/Alaskan Native(AI/AN),9(0.2%), and some other race, 727(12.4%). There was overall 92.3% compliance to the recommended schedule. A significant racial variability in MMR as well as HBV were observed, Asian (98.5%), AA (98.4%) and Caucasian (97.1%), c2(7)¼20.6, p¼0.01, and Asians (99.3%), AA(94%) and Caucasian (98.7%), c2(7)¼23.9, p¼0.001 respectively. Asians demonstrated highest compliance in the receipt of varicella (Asians [99.3%], AA [98.6%], and Caucasian [97.1%], c2(7)¼18.7, p¼0.01, and toxoid poliovirus (Asians[100%], AA[99.4%] and Caucasian [99%], c2(7)¼12.3, p¼0.09. Asians (97.0%) relative to AA (93.1%) and Caucasian(91%) demonstrated the highest compliance in all vaccines combined, c2(7)¼24.5, p¼0.001. Caucasians and AA, relative to Asians were 69% (Odds ratio [OR]¼ 0.42, 95% CI, 0.15-1.14, and 58%, (OR¼0.31, 95%CI, 0.11-0.85) less likely to adhere to the CDC schedule respectively. after controlling for insurance status, the significant racial disparities did not persist between Asians and Caucasians, adjusted OR, 0.45, 99%CI,0.08-1.11. Conclusion: Asians demonstrated highest compliance, indicative of racial/ ethnic disparities.
P42. CDC'S First National Tobacco Education Campaign's Impact on Quitline Caller's Intermediate Cessation Outcomes A. Malarcher, L. Zhang, K. Vickerman, P. Mowery. Office on Smoking and Health, CDC, Atlanta, Georgia; Alere Wellbeing, Seattle, Washington Purpose: To educate the public on the immediate health damage caused by smoking and to encourage smokers to quit, the Centers for Disease Control and Prevention launched the first federally-funded National Tobacco Education Media Campaign e Tips From Former Smokers (TIPS) e for 3 months in 2012. This study examined the Campaign's impact on callers’ quit attempts and on cessation. Methods: Using 22 states and DC's quitline data, we compared the number of callers and callers who received services during the 2012 TIPS campaign to the previous year. Using multivariate logistic regression controlling for confounding factors, we examined the relationship between TIPS exposure (gross rating points) and 24 hour quit attempts or 7+ day cessation during treatment. Results: The number of unique quitline callers and callers who received counseling or NRT increased 88.6% and 70.8%, respectively during the TIPS campaign compared to similar weeks in 2011. Greater numbers of callers reported positive intermediate cessation outcomes during the TIPS campaign; although proportionally fewer engaged in these behaviors compared to the previous year. Higher TIPS campaign exposure was positively associated with intermediate cessation outcomes among persons from states with higher tobacco control funding. Conclusion: An evidence-based national tobacco education campaign with adequate reach and frequency can lead to substantial increases in quitline use and intermediate cessation outcomes.
P43. Differences in Blood Ambulatory Care Settings
Pressure
Measurement
in
W.S. Pearson, R. Merritt. Office of Prevention through Healthcare, Centers for Disease Control and Prevention, Atlanta, GA Purpose: Blood pressure (BP) monitoring is an important tool in preventing both morbidity and mortality from heart disease. Each point of contact with the healthcare system provides this opportunity. This study compared numbers of visits where BP was measured at the time of the visit for different ambulatory care settings. Methods: Data were taken from three years (2008-2010) of the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to produce estimates of the numbers of visits to both community-based physician offices and hospital-based outpatient departments that performed a BP measurement at the time of visit.