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Border County Health Workforce Profiles: Arizona
 

Appendix B. Data Sources

Overview of Data Sources Border States 

Population

Census data and country estimates from the U.S. Census Bureau were used to calulate the size of the population at the county level for each of the Border States. Population Division, Population Estimates Program (Release Date: August 11, 2005).

figures used for calculating the health provider-to-population ratios in this report are based on updated data from the U.S. Census Bureau,

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, was purchased from the respective Board in each State.  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 [124] , addresses were matched by “relaxing” the zip code; this allows 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 reflects place of residence of each case, not the place of occurrence.

Data from Licensing Boards in Arizona

Data for each of the health professions discussed in the current report was received from each of the respective licensing boards in Arizona.  While special issues with each of the data sets were discussed below, the following table highlights the proportion of data that were 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 Arizona


Variable
Physicians
Dentists
Registered Nurses
Race/Ethnicity
NA
NA
5.6
Age
NA
NA
NA
Gender
NA
NA
<1.0
Patient Care
NA
NA
NA
Specialty
<1.0
0.0
A
Hours/Week or Part-/Full-Time
NA
NA
NA
NA= Not available
A= Available

RCHWS was unable to obtain codes to determine which health professionals provide direct services to the population using data from Arizona licensure boards.  Thus, this report includes all professionals with an active license and does not reflect the number of health professionals providing direct patient care in their respective health fields.

Physicians and Physician Assistants

License data for allopathic physicians (MDs) and physician assistants (PAs) was received from the Arizona Medical Board in March 2004.  License data for osteopathic physicians (DOs) were received from the Arizona Board of Osteopathic Examiners in Medicine and Surgery and reflects a date of August 2004.

Physician license data used in this analysis, as well as PA data, lacked many of the data elements requested for this report.  Specifically, data for any of the three demographic variables (age, sex, and race/ethnicity) were not available.  While the Board does not collect information on race/ethnicity, it declined to release information on age and sex.  In addition, information which indicated whether the health professional was working in a full- or part-time position was not available.  Most importantly, there was no information available to identify whether physicians or PAs provide direct patient care.  Specialty information was available for physicians which allowed for identification of those providing primary care.

An additional problem with data for physicians and PAs was the availability of only one 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 address in the data set reflected the health professional’s home or business/practice address.

Dentists

License data for dentists in Arizona was received from the Arizona State Board of Dental Examiners and reflects a date of February 2004.

Dentist license data used in this analysis contained no information for age, sex, or race/ethnicity.  The Board indicated that demographic information was not available.  In addition, the following information was also not available for analysis: Employment in a full- or part-time position or ability to identify dentists in private practice (used as an indicator of direct patient care).  Information was available for specialty which allowed for identification of dentists in a dental specialty area.

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

Registered Nurses

License data for registered nurses was received from the Arizona State Board of Nursing and reflects a date of August 2004.

The registered nurses’ data used in this analysis contained information regarding race/ethnicity and gender of nurses with an active license in Arizona.  Unfortunately, the Board declined to release information about age for nurses.  Other information that was not available for registered nurses include working in a full- or part-time nursing position and codes for nurses providing patient care.  However, specialty information was available for specialty nurses in separate files.  These separate files were matched to the active nurses file in order to compute the number of active specialty nurses reported here.

An additional problem with data for registered nurses was the availability of only one address which was geocoded to determine the location of nurse’s practice address.  The problem with this assumption was the inability to determine whether the address in the data set reflected the nurse’s home or business/practice address.

Psychologists

License data for psychologists was received from the Arizona Board of Psychologist Examiners and reflects a date of April 2004.

The only demographic variable available for psychologists with an active license in Arizona was gender.  In addition to race/ethnicity and age, other fields that were not available for psychologists include working in a full- or part-time position and the identification of psychologists providing patient care in a clinical setting.  One strength of data for licensed psychologists in Arizona was the availability of a public/business address which was geocoded to determine the location of the health professional’s reported practice address.Social Workers

License data for social workers was received from the Arizona Board of Behavioral Examiners and reflects a date of April 2004.Demographic information for social workers with an active license in Arizona were not available for this Report.Other information not available for social workers include:  working in a full- or part-time position and the identification of social workers providing patient care in a clinical setting.  A public/business address was geocoded to determine the location of the health professional’s reported practice address.

Social Workers

License data for social workers was received from the Arizona Board of Behavioral Examiners and reflects a date of April 2004.

Demographic information for social workers with an active license in Arizona were not available for this Report. Other information not available for social workers include: working in a full- or part-time position and the identification of social workers providing patient care in a clinical setting. A public/business address was geocoded to determine the location of the health professional’s reported practice address.

Data from Health Offices in Arizona

Vital Statistics

Vital statistics data for 2002 were received from the Office of Vital Statistics, Bureau of Public Health Statistics, Arizona Department of Health Services

Hospital Discharges

Hospital discharge data for 2002 were received from the Bureau of Public Health Statistics, Arizona Department of Health Services

Incidence Data

Breast and Cervical Cancer

Data for breast and cervical cancer cases diagnosed in 2001 was received from the Arizona Cancer Registry, Arizona Department of Health Services.

HIV/AIDS

Number of HIV/AIDS cases diagnosed from 1998 through 2002 were retrieved on May 14, 2004, from http://www.hs.State.az.us/phs/hiv/pdf/counties.pdf.

Hepatitis A and B

Data for hepatitis A and B cases diagnosed in 2002 was received from the Infectious Disease Epidemiology Section, Office of Infectious Disease Services, Public Health Services; Arizona Department of Health Services. Data on chronic hepatitis B cases were not available for each of the Border States, but were available for Arizona.

Tuberculosis

Number of tuberculosis (TB) cases identified in 2002 and 2003 was provided by the Arizona Department of Health Services, Tuberculosis Control Program, Office of Infectious Disease Services, Public Health Services.

Immunizations

Information about childhood immunization status for 2003 was obtained from the Centers for Disease Control and Prevention, National Immunization Program (NIP). The National Immunization Survey (NIS) provides immunization status for States, but not counties. Results were also not available for all race/ethnic groups. For Arizona, State level results were available for Non-Hispanic Whites and Hispanics/Latinos(as) only.

The Arizona State Immunization Information System (ASIIS) allows for the collection of immunizations to children ages 18 and under. Legislation passed in Arizona creates the mechanism for providers to report immunization information to the State registry. However, the registry cannot currently be used to calculate coverage estimates because not all providers report all immunizations to the registry. As a result, Arizona relies on the National Immunization Survey (NIS) for coverage rates, as noted in the current report. Arizona does not conduct retrospective surveys as was the case in other States.
   
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