title: Safety-net facilities and hospitalization rates of chronic obstructive pulmonary disease: a cross-sectional analysis of the 2007 Texas Health Care Information Council inpatient data.
abstract: OBJECTIVE
  Geographic disparities in hospitalization rates for chronic obstructive pulmonary disease (COPD) have been observed in Texas. However, little is known about the sources of these variations. The purpose of this manuscript is to further explore the geographic disparity of COPD hospitalization rates in Texas by examining county-level factors affecting access to care.
  
  
  METHODS
  The study is a cross-sectional analysis of the 2007 Texas Health Care Information Council, Texas, demographer population projections and the 2009 Area Resource File (ARF). The unit of analysis was county-specific hospitalization rate, calculated as the number of discharges of county residents divided by county-level population estimates. Indicators of access to care included: type of safety-net facility and number of pulmonary specialists in a county. Safety-net facilities of interest were federally qualified health centers (FQHCs) and rural health clinics (RHCs).
  
  
  RESULTS
  There was a significant difference (P < 0.05) in hospitalization rates according to health center presence. Counties with only FQHCs had the lowest COPD hospitalization rate (132 per 100,000 observations), and counties with only RHCs had the highest hospitalization rate (229 per 100,000 observations). The presence of a pulmonary specialist was associated with a significant decrease (25%) in hospitalization rates among counties with only FQHCs.
  
  
  CONCLUSIONS
  In Texas, counties with only FQHCs were associated with lower COPD hospitalization rates. The presence of a RHC alone may be insufficient to decrease hospitalizations from COPD. There are a number of factors that may contribute to these variations in hospitalization rates, such as racial/ethnic distribution, types and quality of services provided, and the level of rurality, which creates greater distances to care and lower concentration of hospitals and pulmonary specialists.
authors.affiliation: Department of Biostatistics, University of North Texas Health Science Center School of Public Health, Fort Worth, TX, USA.
authors.forename: Bradford E
authors.initials: BE
authors.lastname: Jackson
authors.forename: Sumihiro
authors.initials: S
authors.lastname: Suzuki
authors.forename: David
authors.initials: D
authors.lastname: Coultas
authors.forename: Fenghsiu
authors.initials: F
authors.lastname: Su
authors.forename: Ravi
authors.initials: R
authors.lastname: Lingineni
authors.forename: Karan P
authors.initials: KP
authors.lastname: Singh
authors.forename: Alfred
authors.initials: A
authors.lastname: Bartolucci
authors.forename: Sejong
authors.initials: S
authors.lastname: Bae
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D061214:Patient Safety / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D015272:Pulmonary Medicine / Q000706:statistics & numerical data; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013781:Texas; D055815:Young Adult