Appendix B.  Data Sources

Overview of Data Sources

Population

Census data and county estimates from the U.S. Census Bureau were used to calculate the size of the population at the county-level for each of the Border States.  Population figures used for calculating the health provider-to-population ratios in this report are based on updated data from the U.S. Census Bureau, Population Division, Population Estimates Program (Release Date:  August 11, 2005).

Prevalence Data

Data for 2002 from the Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate the proportion of the population:  without health coverage; ever diagnosed with diabetes; who are overweight or obese; who have had a dental visit within the past year; and, who currently have asthma.  In addition, the proportions of females who had a pap smear or mammogram were also estimated.

The BRFSS is a survey that collects information about adults (18 and older and living in households); persons younger than 18 are not represented by the survey results provided in this report.

While the sample allows estimates to be produced for areas, such as the Border regions in each of the Border States, most counties do not have large enough samples to produce reliable estimates for individual counties.

State Licensure Data

Agencies in each State that handle data for licensed health professionals were contacted to obtain data for the current report.  Among these were State boards for physicians, dentists, registered nurses, physician assistants, psychologists, and social workers.  Psychiatrists and three categories of specialty nurses were identified when specialty information or another designator was included in the data sets.

Delays in obtaining data resulted in inconsistencies in the reporting date of the data as most licensing boards process and compile data requests on an as needed basis and this Study may have had a lower priority rating at one board than at others.  Reporting dates were included in the respective tables in the report.

The health professions data used in this report, in most cases, were purchased from the respective Board in each State.  Licensure Boards most often receive requests for mailing lists.  Consequently, for some boards, a mailing list was purchased only when no other data were available for analysis.  Some boards were able to include additional variables to mailing lists.

State Health Data

Vital statistics, hospital discharge, and incidence data for selected diseases were also requested from State health departments to present the health status of the regions as well as State totals.  Healthy Border 2010 Objectives guided the selection of health indicators used in this report.

Description of Geocoding Process

State Licensure Data

Data received from State licensure boards or State organizations were “geocoded” using Geographic Information Systems (GIS) software in an effort to determine the location of the health professional.  This permitted assignment of health professionals to a county based on the county Federal Information Processing Standards (FIPS) code assigned by the GIS software.  The following process describes the method by which an address was “geocoded.”  The address used was determined by staff (in consultation with the suppliers of the data when possible) to best represent the practice location of the health professional.  Using batch processing, on the first pass, addresses were matched only on the exact street name, house number and zip code.  On the second pass^[143], addresses were matched by “relaxing” the zip code; this allowed a match for address in a different zip code.  On the third pass, street name and house number for the address were relaxed to allow matches for parameters similar to address components (such as misspellings to be matched to the address).  On the final geocoding pass (usually by this stage only a small percentage of records were not matched), records were matched by zip code only.  Once these passes were complete, remaining unmatched records were viewed through interactive mode in GIS to determine if a match could be made by searching for visible errors in the address field.  Once geocoding was completed, data were moved into Statistical Package for the Social Sciences (SPSS) software.  The remaining unmatched records were assigned a county in SPSS based on the city name.  For example, since PO Box addresses could not be geocoded, they were assigned a county FIPS code based on the name of the city.

State Health Data

Health related information such as vital statistics, hospital discharge, and incidence data, were usually assigned a county code by the State agency/office responsible for the data.  Data reported here reflect place of residence of each case, not the place of occurrence.

Data from Licensing Boards in Florida

Data for each of the health professions discussed in the current report were purchased from Medical Quality Assurance (MQA), Florida Department of Health, and reflect a date of June 2004.

Data for the health professions described in this report is submitted to the MQA via the PRAES licensing database which handles the application and licensing process for each of the health professions discussed in this report.  While Florida has the capacity to record data related to the demographics of its health professionals, this part of the licensing process is not required and, therefore, some data may be missing (not entered into the system).  The following table illustrates the proportion of data that was not available (NA) by type of variable for the three types of primary care professionals:

Proportion of Missing Data for Physicians, Dentists, and Registered Nurses in Florida

NA= Not available
A= Available

Of the three demographic variables, race/ethnicity tends to have the largest proportion of data that were not entered for each of the three professions, while gender was the next variable less often entered by dentists and registered nurses.  However, because Florida was able to collect this data for each of the health professions, it was ahead of many other Border States merely by the fact that it was able to capture this information through its licensing system.

Codes were not available which ascertained which health professionals provided direct services to the population using data from the MQA.  Thus, this report includes all professionals with an active license and does not reflect the number of health professionals who provided direct patient care in their respective health fields.

A high proportion of specialty data for physicians (30 percent) was not entered into the system.  Unfortunately, it was not known whether a large proportion of this missing data was for active physicians providing patient care or if this was mostly comprised of physicians who were not practicing.  In the case of dentists, specialty information was not available.

An additional problem with Florida data was the availability of only a mailing address which was geocoded to determine the location of the health professional’s reported place of practice.  The problem with this assumption was the inability to determine whether the mailing address in the data set reflected the health professional’s home or business/practice address.

Data from Health Offices in Florida

Vital Statistics

Vital statistics data for 2002 were received from the Office of Vital Statistics, Florida Department of Health.

Hospital Discharges

Hospital discharge data for 2002 were received from the Agency for Health Care Administration, State Center for Health Statistics, Florida Department of Health.

Incidence Data

Breast and Cervical Cancer

Data for breast and cervical cancer cases diagnosed in 2001 were received from the Bureau of Epidemiology, Florida Department of Health.

HIV/AIDS

Data for HIV/AIDS cases diagnosed in 2001 were received from the Bureau of HIV/AIDS, Florida Department of Health.

Hepatitis A and B

Data for hepatitis A and B cases diagnosed in 2003 were received from the Bureau of Epidemiology, Florida Department of Health.

Tuberculosis

Data for tuberculosis cases diagnosed in 2002 and 2003 were provided by the Bureau of Tuberculosis and Refugee Health, Division of Disease Control, Florida Department of Health.

Immunizations

Information about childhood immunization status for 2003 was obtained from the Centers for Disease Control and Prevention, National Immunization Program (NIP).  While State level data were available through the NIP’s National Immunization Survey (NIS), results were not available for all race/ethnic groups.  For Florida, State level results were only available for Non-Hispanic Whites and Hispanics/Latinos(as).