Health Services Research Collaborative

About Us

Welcome

The mission of the Houston Health Services Research Collaborative is to promote and facilitate interdisciplinary research directed at improving policy and health outcomes of low-income and uninsured populations in the greater Houston area.

Our work is funded in large part by the Houston Endowment (HoustonEndowment.org), with some projects receiving funding from elsewhere. Each project is coordinated by a faculty investigator and a graduate student.

Goals & Objectives

Goals

  • To facilitate and enhance research and analyses related to public health and healthcare problems in Houston, particularly of low-income, uninsured, and other vulnerable populations.
  • To facilitate and enhance research and analyses of policy and program initiatives aimed at expanding the capacity and performance of the public health and health care safety net in Houston

Objectives

  • Organize working groups in topical areas to increase research awareness, encourage coordination, and foster new activity.
  • Identify existing research resources in the community and assist in directing them to meet community research needs.
  • Develop, manage, and facilitate the shared use of databases to monitor local health problems and health service performance.
  • Participate in and provide assistance to policy and program planning initiatives.

Affiliated Organizations

The following is a list of past and present organizations with whom we have worked.

Organizations

Staff

Emergency Room study

Description: This is an annual survey of hospital emergency room visits in Houston area hospitals. The first survey was conducted in 2003. In recent years the study has included approximately two thirds of the hospital based ERs that serve the Houston 911 service area.

Community benefits resulting from ED Utilization Study (PDF)

Emergency Room Use and Access to Primary Care: Evidence from Houston, Texas (NIH.gov, published in 2006)

Who Uses Hospital Emergency Rooms? Evidence from Houston/Harris County Texas (JHU.edu, published in 2010)

Houston Hospitals ER Utilization Study – 2011 (published in June 2013) (PDF, published in June 2013)

Houston Hospitals ER Utilization Study – 2010 (PDF, published in June 2012)

Presentation on 2010 ER study (PDF, presented on June 2, 2012)

Population rates of ER visits in Harris County, 2010 (PDF, published in June 2012)

Houston Hospitals ER Utilization Study – 2009 (PDF, published in May 2011)

Rates for select types of emergency room visits in Harris County in 2009 (PDF)

Top 2009 ER diagnoses by age and payer source (PDF)

Houston Hospitals ER Utilization Study – 2008 (PDF, published in 2010)

ER Visits with an Ambulance Transport in 2008 (PDF)

Ambulance Transports Vs. Self Transports to the ER in 2008 (PowerPoint 2003)

Maps from the 2008 ER study (PowerPoint 2007)

Maps from the 2008 ER study (PowerPoint 2003)

Medicaid and CHIP Kids With Primary Care Related ED Visits (PowerPoint 2003)

Houston Hospitals ER Utilization Study – 2007 (PDF, published in 2009)

Executive Summary of 2007 Study (PDF)

ZIP Code Level ED Data on Children Age 0 to 17 (PDF)

Houston Hospitals ER Utilization Study – 2006 (PDF, published in 2008)

Technical and background information for 2006 ER study (PDF)

Brief summary of 2006 ER study (PDF)

Expenses for a Hospital Emergency Room Visit, 2003 (AHRQ.gov, national estimates referenced in 2006 ER report)

Are the Uninsured Responsible for the Increase in Emergency Department Visits in the United States? (NIH.gov, article abstract)

Houston Hospitals ER Utilization Study – 2005 (PDF, published in 2007)

Houston Hospitals ER Utilization Study – 2004 (PDF, published in 2006)

Houston Hospitals ER Utilization Study – 2003 (PDF, published in 2005)

Houston Hospitals ER Utilization Study – 2002 (PDF, published in 2004)

Emergency Department Visits for Behavioral Health Conditions in Harris County, 2004-2006 (PDF)

Emergency Department Visits for Behavioral Health Conditions in Harris County, 2007-2008 (PDF)

Safety Net

The Healthcare Safety Net

Description: Present data on indicators of safety net need, capacity, and performance. Describe new initiatives, activities, and subsequent unaddressed issues that have occurred since 2004. Describe current views of the findings, evidence, and recommendations of the Harris County Public Health Task Force Report with regard to access and coverage, service delivery, financing and cost.

Harris County Health Care Safety Net: Where We Stand 2010

Primary Care Demand and Supply

Description: Estimate the demand for primary care among the low-income, uninsured population in Houston/Harris County area. Measure the supply of primary care of safety net providers in Houston/Harris County area. Estimate the gap between demand for and supply of primary care for the low income, uninsured population in Houston/Harris County.

Health Reform and Primary Care Capacity: Evidence from Houston/Harris County, Texas (article published in 2012)

Health Reform and Primary Care Capacity (PDF)

Assessment of the Need for Safety Net Primary Care in Harris County (PowerPoint 2003)

Location of Retail/In Store Clinics and Rate of Primary Care Related ED Visits by the Uninsured Per 1,000 People (PDF)

The Impact of Extended Hours Primary Care on Emergency Department Use (PDF)

Primary Care Demand and Supply (PDF)

 

Safety Net Services

These are some (but not all) of the safety net services and providers in the community:

Gateway To Care

Harris County Healthcare Alliance

Harris  County Hospital District

Project Safety Net (part of St. Luke’s Episcopal Health Charities)

Denver Harbor Clinic

Good Neighbor Healthcare Center

Ibn Sina Foundation

Legacy Community Health Services

Insurance Coverage

The Uninsured in Houston and Harris County

Description: Estimate the current number and rate of the uninsured population in Houston, Texas, at the sub-county (e.g., ZIP Code, census tract) level over a three year period. Project the estimated numbers and rates of the uninsured population in Houston, Texas, at the sub-county level, to the year 2020.

The Impact Of The Patient Protection and Affordable Care Act on Healthcare Coverage in the Houston-Galveston Area (PDF)

Estimation and Forecasting of the Uninsured in Houston (PDF)

Medicaid and CHIP

Frequency and rates of Medicaid and CHIP enrollment for every county in Texas (2010 and 2011)

Frequency and rates of Medicaid and CHIP enrollment for ZIP codes in southeast Texas (2010 and 2011)

Total Medicaid enrollment in the greater Houston area in 2011 – broken down by race/ethnicity (PDF)

2007 Medicaid Enrollees by County in Southeast Texas (PDF)

2007 Aged Medicaid Enrollees by County in Southeast Texas (PDF)

County Level Population Estimates by Age for Southeast Texas (PDF)

Gateway to Care CHIP Education Project Evaluation (PDF, a report for HHSC and GTC)

Medicaid and SCHIP – Enrollees and Providers (PDF)

Other

Trends in Preventable Hospitalizations in Harris County

Description: The objectives of this study are to examine trends in the overall and disease-specific rates of preventable hospitalizations (PH) in Harris County from 2003-2007, as well as changes in and the persistence of the individual and geographic characteristics of those with PH admissions.

Preventable Hospitallizations for Ambulatory Care Sensitive Conditions (PDF)

The Local Trauma System

Emergency Department Diversion and Trauma Mortality: Evidence from Houston, Texas (NIH.gov)

Impact of Hurricane Ike on the Trauma System in Southeast Texas (PDF)

Mental/Behavioral Health Services

Community Behavioral Health Program (PDF, evaluation report)

Emergency Department Visits for Behavioral Health Conditions in Harris County, 2004-2006 (PDF)

Emergency Department Visits for Behavioral Health Conditions in Harris County, 2007-2008 (PDF)

Houston Endowment documents

Houston Endowment – year one report (PDF)

Houston Endowment – year two report (PDF)

Data

Databases

The Texas Health Care Information Collection (THCIC) Hospital Discharge Database

Provided by Texas Department of State Health Services (TDSHS), used for the study of preventable hospitalizations.

Overview

The Texas Health Care Information Collection was created in September 1995 by the Texas State Legislature to obtain hospital inpatient discharge data and health maintenance organization performance data (Section 108). All state licensed hospitals (excluding statutorily exempt “rural providers”) are required to submit inpatient discharge data on all patients to the THCIC. The quality of the data is assured by the agency.

Contents

The THCIC discharge data contains information on patient demographics, source of admission, length of stay in days, discharge status (alive or dead), diagnosis (primary and secondary ICD-9-CM code), charges (accommodation and ancillary), source of payment, risk mortality (likelihood of dying), severity of illness (organ system loss of function), as well as other information (hospital facility ID, hospital name, source of admission, admission/discharge dates, and address and zip codes of patients and hospitals).

Access

* Statewide and regional data are available by quarter from 1999 to 2005.

Usage

  1. Describe trends in trauma care and determine if there is a correlation between hospital emergency room diversion status and trauma care outcomes.
  2. Reference: Emergency Department Diversion and Trauma Mortality: Evidence from Houston, Texas (NIH.gov). Charles E. Begley et al. The Journal of TRAUMA. 2004; 57:1260-1265).
  3. Click here (PDF) for a presentation about the THCIC hospital discharge data.
  4. Reference: CODE RED: The Critical Condition of Health in Texas. Browse to http://www.coderedtexas.org/ for full version of contents.

The Behavioral Risk Factor Surveillance System (BRFSS) Survey Data

Supported by the Texas Department of State Health Services and the Centers for Disease Control and Prevention (CDC)

Overview

The Behavioral Risk Factor Surveillance System (BRFSS) was initiated in 1984, with 15 states collecting surveillance data on risk behaviors through monthly telephone interviews. Currently all states are participating in BRFSS. The objective of the BRFSS is to collect uniform, state-specific data on preventive health practices and risk behaviors that are linked to chronic diseases, injuries, and preventable infectious diseases in the adult population. The BRFSS is a collaborative project of the Centers for Disease Control and Prevention (CDC) and U.S. states and territories. The BRFSS is an ongoing data collection program designed to measure behavioral risk factors in the adult population (18 years of age or older) living in households. Factors assessed by the BRFSS include tobacco use, health care coverage, HIV/AIDS knowledge and prevention, physical activity, and fruit and vegetable consumption. BRFSS field operations are managed by state health departments.

Contents

Information includes health status, demographics, health care access, women s health, hypertension awareness, immunization, cholesterol awareness, colorectal cancer, screening diabetes, injury control, tobacco use (smoking), HIV/AIDS, alcohol consumption, skin cancer, and more.

Prevalence data contain 28 categories such as diabetes, asthma, exercise, women s health and so forth.

Trend data contain 16 categories such as alcohol use, smoking, overweight, and so on.

SMART (Selected Metropolitan/Micropolitan Area Risk Trends)

Local area health risk data; 28 categories contained

Access

Data and materials produced by federal agencies may be reproduced without permission via public domain. User s Guide may be obtained via this link (CDC.gov).

Data availability: Roughly six to seven months after the data has been collected for a given calendar year the CDC makes a public use data file available via the BRFSS Website (CDC.gov).

Usage

  1. Identify demographic variations in health related behaviors and address emergent and critical health issue regarding behavioral risk factors in the community and propose legislation for health initiatives.
  2. Reference: http://www.dshs.state.tx.us/chs/brfss/pages/riskf.shtm
  3. There are two BRFSS downloadable datasets. Click here (PDF) for a presentation about SMART (estimates for local area) and here (PDF) for a presentation about the state level BRFSS data. Both documents describe how to obtain and analyze the data.

For additional information email Patrick Courtney or contact the Texas Department of State Health Services for THCIC or BRFSS.

Emergency Department Visits

Data is collected directly from participating hospitals on a voluntary basis. With few exceptions, the invitation goes out to any general emergency room that accepts transports from the Houston 911 service area (parts of which stretch into adjacent counties).

Medicaid and CHIP enrollment Data

The Texas Health and Human Services Commission provides general summary level data on their website. The specific information (e.g. ZIP code level) was received directly from them via special request.

US Census Bureau

http://www.census.gov/

Events

Events

Healthcare Safety Net Initiatives Conference: Policy and Performance

February 9, 2007 – The University of Texas School of Public Health

All files below are in PowerPoint 2003 format.

Full conference agenda

Cross-Community Perspective on Healthcare Safety Net Models

Robert Hurley – Department of Health Administration, Virginia Commonwealth University

Measuring Performance of Healthcare Safety Nets

John Billings – Center for Health and Public Research, New York University

Texas Initiatives – Austin

Ann Kitchen – Austin Indigent Care Collaboration

Texas Initiatives – San Antonio

Juanita Simmons – CareLink, University Health System

Integrating Public Health and Safety Net Care

Eduardo Sanchez – The University of Texas School of Public Health

Emergency Department Utilization in Harris County and Safety Net Primary Care

Patrick Courtney – The University of Texas School of Public Health

Insurance Products – Houston

Karen Love – Harris County Healthcare Alliance

Insurance Products – Galveston

Barbara Breier – Center to Eliminate Health Disparities, The University of Texas Medical Branch

Houston Healthcare Decisions Survey

Pamela Behan (University of Houston-Downtown) and Patrice Williams (The University of Texas School of Public Health)

Preventable Hospitalizations

Yu Fang (Frances) Lee – The University of Texas School of Public Health

Healthcare for the Homeless

David Buck (Healthcare for the Homeless) and Karen Love (Harris County Healthcare Alliance)

Community Behavioral Health Program

Mark Kunik – Baylor College of Medicine

Jail Diversion/Juvenile Probation Evaluations

Scott Hickey – Mental Health and Mental Retardation Authority of Harris County

Emergency Call Center

David Persse – Houston Emergency Medical Services

ER Medical Screening

Tom Granchi – Ben Taub General Hospital

EMS/Trauma Performance

Charles Begley – The University of Texas School of Public Health

Kelsey Research Foundation – 8th Annual Health Services and Outcomes Research Conference

November 6, 2007

All files are in PDF format. Only poster presentations by Health Services Research Collaborative members are listed here. For printing purposes, legal size paper is recommended.

Emergency Room Use: Evidence from Houston, Texas

Impact of Convenience Care on Pediatric ED Utilization

Population Characteristics and Preventable Hospitalizations in Harris County: 2004

Predictors of Pretrial Jail Diversion in Houston Texas

Trauma Capacity and Outcomes in Texas: Regional Comparison by Multilevel Model

ER Visits in Houston Area Hospitals and Strategies to Reduce Them

April 3, 2008 – Sponsored by Gateway to Care, Harris County Healthcare Alliance, and the UT School of Public Health.

All files are in PowerPoint 2003 format.

For the complete report on the analysis of 2006 ER visits (and/or a brief summary of the report), click the Research & Reports tab above.

2008 Houston Hospitals ER Visit Study Report

Charles Begley, Professor, UT School of Public Health, Director, Houston Health Services Research Collaborative

Patrick Courtney, Research Associate, UT School of Public Health, Proj. Coord., Houston Health Services Research Collaborative

After Hours Primary CareThe El Centro Project, El Centro de Corazon, Texas Children’s Health Plan

Leah Fischer, Graduate Student, UT School of Public Health

The Role of Navigators - The CHIP Education Project, Gateway to Care, Harris Cty Hosp District

CHIP Education Project – Karin Dunn, Manager, Navigation Services, Harris County Hospital District and Gateway To Care

CHIP Education Project Evaluation – Carlos Ramos, Graduate Student, UT School of Public Health

Frequent User ProgramsCommunity First Medicaid/CHIP Frequent Flyer Program

Rodolfo Urby, Vice President and Senior Medical Director

Hospital ER Screening - RightCare Program, Harris County Hospital District

Pete Dancy, Associate Administrator, Ben Taub General Hospital

Case ManagementCongestive Heart Failure Intervention, Memorial Hermann Healthcare System

ER Navigator – Carol Paret, Chief of Community Services, MHHS

Congestive Hearth Failure Disease Management Program – Pat Metzger, Chief of Care Management, MHHS