Graduation Year

2006

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Nursing

Major Professor

Mary Evans, Ph.D.

Keywords

Avoidable, Hospitalization, Quality, Indicator, Disparity

Abstract

Background: Hospitalizations for pediatric gastroenteritis are considered potentially avoidable and are used to monitor access and quality of primary care for children. Previous reports have found pediatric gastroenteritis admissions higher in Florida compared to the South and the nation.Purpose: The purpose of this project was to explore variation in county admission rates for pediatric gastroenteritis related to non-clinical factors in Florida during 1995-2002. Specific aims included identifying the unique contributions of county socioeconomic characteristics and availability of primary care resources to annual county pediatric gastroenteritis hospital admission rates. Method: The study was retrospective and longitudinal assessing variation in annual county admission rates for pediatric gastroenteritis from 1995 to 2002. Secondary data sources included Florida hospital discharge data and multiple publicly available state and federal datasets. Explanatory variables included county-level measures of socioeconomic status and primary healthcare resources. Analysis: Multivariate analysis was performed using multilevel modeling techniques. A two-level, random coefficients model was constructed in HLM6 to account for variation over years and across counties. Linear and non-linear trends over time were also assessed. Results: None of the hypotheses were supported by the data. The average pediatric gastroenteritis admission rate across all occasions and counties was 205.72 admissions per 100,000 child population. The proportion of children 0-4 years was the only significant predictor of pediatric gastroenteritis rates. Conclusion/Discussion: The significant effect of age on admission rate was not surprising and was well supported in the literature. Missing data issues and low statistical power may have contributed to the lack of significant effects of other explanatory variables

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