Access to Health Services

 

Overview

Healthy Vermonters & Healthy People
Methods

Vermont Data Sources
Analysis Geography
Suggested Citation

 

Overview

The data contained in these maps, tables, and graphs represent the most complete and recent information available to the Vermont Department of Health about health status indicators of the Vermont population. However, as with any data, there are some limitations to keep in mind when interpreting the results.

Variety: Healthy Vermonters 2020 uses over 40 sources of data and each has its strengths and limitations. Some data are from national surveys or mandated surveillance while others are from internal tracking systems or program reporting. Data used for Healthy Vermonters 2020 may not apply in other states.

Data Quality: Several precautions were taken to ensure the reliability and validity of the data for each objective. Survey questionnaires were carefully designed and thoroughly tested by the Centers for Disease Control and Prevention. Survey results are statistically adjusted or “weighted” so that the sample accurately represents Vermonters. Non-survey data rely on completeness and methodology checks as well. Finally, all analyses were performed in duplicate. These precautions can reduce some sources of error, but not all.

Comparisons: It is natural to want to compare Vermont to the U.S. as a whole as well as to other states. Unless data sources and methodology are equivalent, we do not recommend this. Within Vermont we have used consistent data sources and methodology but we urge caution in making comparisons between counties, Health Department district offices areas (Districts), and hospital service areas (HSAs). Often there are many underlying differences in a region that are important context for understanding the story told by the data. Additionally, small differences may not be statistically different and may simply be a function of normal sampling error. Given this, we have chosen to display the statistical comparison, based on 95% confidence intervals, between the statewide statistic and the local region. Comparisons across regions are not displayed.

What, not Why: The health status indicators included in Healthy Vermonters 2020 reveal what behaviors Vermonters are doing. However, the indicators alone cannot answer why they are doing those behaviors.

 

Healthy Vermonters & Healthy People

Healthy Vermonters 2020 is considered the Vermont State Health Assessment and an important component of Vermont’s public health work. Healthy Vermonters is based on the U.S. Department of Health and Human Services Healthy People Initiative that “provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time.”

 

The Healthy Vermonters Objectives align with these Healthy People 2020 Objectives

Healthy Vermonters Objectives

Healthy People 2020 Objectives

% of Vermonters with health insurance

AHS-1.1

Increase the proportion of persons with medical insurance

% of adults age 18-64 with health insurance

AHS-1.1

Increase the proportion of persons with medical insurance

% of children age 17 or younger with health insurance

AHS-1.1

Increase the proportion of persons with medical insurance

Number of practicing Primary Care Provider FTEs – Physicians (MD and DO)

AHS-4.1

(Developmental) Increase the number of practicing medical doctors

AHS-4.2

(Developmental) Increase the number of practicing doctors of osteopathy

Number of practicing Primary Care Provider FTEs – Physician Assistants

AHS-4.3

(Developmental) Increase the number of practicing physician assistants

Number of practicing Primary Care Provider FTEs – Nurse Practitioners

AHS-4.4

(Developmental) Increase the number of practicing nurse practitioners

% persons with insurance coverage for clinical preventative services

AHS-2

(Developmental) Increase the proportion of insured persons with coverage for clinical preventive services

% of adults with a usual primary care provider

AHS-3

Increase the proportion of persons with a usual primary care provider

% of all Vermonters with a specific source of ongoing care

AHS-5.1

Increase the proportion of persons of all ages who have a specific source of ongoing care

% of adults who cannot obtain care or delay care

AHS-6.1

Reduce the proportion of persons who are unable to obtain or delay in obtaining necessary medical care, dental care, or prescription medicines

 

 

More information on the methodology used in Healthy People 2020 is available from the Health Indicators Warehouse. For example, whether or not an indicator was age-adjusted to the U.S. standard population is noted in the Data tab of the Warehouse web pages. As a general rule, Vermont statistics align with this methodology.

 

Methods

Prevalence and percentages were calculated by using descriptive statistical procedures using software such as SPSS, SAS, and/or SUDAAN.  These statistics describe the proportion of individuals with a given trait in the population during a specified period of time.

Mortality rates were calculated based on the ICD-10 code for the underlying cause of death listed on death records received by Vital Records. Only Vermont residents were included in these calculations.  Rates were calculated by comparing the number of deaths in a given time period to the overall population of Vermont in the same time period.

Discharge rates were calculated using the Vermont Uniform Hospital Discharge data set. We looked at all hospital and ED discharge among Vermont residents who utilized services at regional hospitals (including hospitals in bordering states).  We compared the number of discharges in a given time period to the Vermont population in the same time period to calculate discharge rates.

In U.S. data, age adjustment is used for comparison of regions with varying age breakdowns. In order to remain consistent with the methods of comparison at a national level, some statistics in Vermont were age adjusted.  In cases where age adjustment was noted as being part of the statistical analysis, the estimates were adjusted based on the proportional age breakdowns of the U.S. population in 2000.  For more detailed information on age adjustment visit http://www.cdc.gov/nchs/data/statnt/statnt20.pdf.

Confidence Intervals were used for statistical comparisons between the state and the various sub-geographies statisticsA confidence interval represents the range in which a parameter estimate would fall which is calculated based on the observed data.  For this analysis, we used a 95% confidence interval, meaning that we are 95% confident that the true value of the parameter being examined falls within the specified confidence interval.  Statistical significance is assessed by comparing the confidence intervals of different groups.  If the confidence intervals from two groups, such as that for the state and a specific county, do not overlap we consider the estimates to be significantly different from one another. 

Note: For indicators using the American Community Survey (ACS) data, z-scores were used for statistical comparison instead of confidence intervals. Z-scores were calculated to determine if the difference in prevalence or percentage between any sub-state geographies and the state as a whole was statistically significant. Comparisons with z-scores greater than 1.96 were considered significant at the 95% confidence level. 

 

Additional Methods:

Note that beginning in 2011 the CDC implemented changes to the BRFSS weighting methodology in order to more accurately represent the adult population.  In 2011 and later, weights are calculated using an iterative proportional fitting (or "raking") methodology.  This allows the weights to be calculated using a smaller sample size, adjusts for more demographic variables, and incorporates cell phone interview data into estimates.  While these adjustments make the calculations more representative of the population, the changes in methodology also limit the ability to compare results from 2011 forward with those from previous years.  The Vermont Department of Health recommends that comparisons between BRFSS data from 2011 forward and earlier years be made with caution.  Statistical differences may be due to methodological changes, rather than changes in opinion or behavior.

Full-time Equivalencies (FTEs) are defined as 40 hours per week of direct patient care. Data collected from the Health Care Provider Workforce Census includes specialty, practice setting, town(s) of practice and the number of hours per week in clinical practice.  This allows us to calculate full-time equivalency (FTE's) by specialty and by geographic region.  Information on whether practitioners are accepting new patients is also collected.

Some indicators use data from the American Community Survey (ACS) from the US Census Bureau.  In order to perform analysis for most sub-state geographies in Vermont, it is necessary to combine 5 years of ACS data.  Data for most sub-state geographies in Vermont are not available in the 1 year or 3 year ACS data files.

Vermont Data Sources

 

American Community Survey -- ACS

Data (such as insurance, income, education, etc.) on the Vermont population is available from the Census Bureau through the American Community Survey (ACS).  The ACS is an ongoing survey of the U.S. population which replaces the long form Census questionnaire.  To learn more about the ACS, please visit http://www.census.gov/acs/www/.

Data from the Census Bureau’s estimates programs, decennial Census counts, and from the ACS are available using the American Fact Finder web query tool, found here:

http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml 

 

For more information about the American Community Survey, please contact:

Michael Nyland-Funke, Public Health Analyst

802-863-7261

michael.nyland-funke@vermont.gov

 

Behavioral Risk Factor Surveillance System -- BRFSS

Vermont tracks risk behaviors using a telephone survey of adults called the Behavioral Risk Factor Surveillance Survey (BRFSS). The results are used to plan, support, and evaluate health promotion and disease prevention programs. These are used to track Department of Health goals (e.g. Healthy Vermonters 2010), and many other BRFSS data reports.

Since 1990, Vermont, along with the 49 other states, Washington D.C. and U.S. territories, has participated in the BRFSS with the Centers for Disease Control and Prevention (http://www.cdc.gov/brfss). The CDC provides the Vermont Department of Health with funding each year to carry out the survey. Currently, ICF Macro with an office in Burlington, Vermont,  is the interviewing contractor for the Vermont BRFSS.

Several thousand Vermonters are randomly and anonymously selected and called annually. An adult (18 or older) in the household is asked a uniform set of questions. The results are weighted to represent the adult population of the state.

Beginning in 2009, Vermont started interviewing adult residents on cellular telephones as well as landline telephones.  This change ensures the survey is conducted among a representative sample of Vermont adults and was made due to changing telephone patterns with more households using primarily cellular telephones.

For more information about the Behavioral Risk Factor Surveillance System, please contact:

Jessie Hammond, M.P.H., Program Coordinator

802-863-7663

jessie.hammond@vermont.gov

 

Vermont Health Care Provider Workforce Census – VT Provider Census

The Vermont Department of Health has been collecting information on health care providers since 1992.  Data on physicians (MDs and DOs), physician assistants (PAs), and dentists are collected every two years at the time of their relicensing. In the past, a census was conducted of advanced practice registered nurses in each year 1998, 2000, and 2002 – although the Department of Health no longer conducts these. More recent surveys of APRN's have been done by UVM through the AHEC (Vermont Area Health Education Center).

The surveys are intended to include all active providers, acting as a census rather than a sample survey.  For that purpose the respondents are compared with lists of licensees (from the board of medical practice or the secretary of state), and follow-up is conducted to reach those who did not respond.  Final response rate is usually above 99%.  Included in the reports are those practitioners who provide patient care in Vermont.  Excluded are the substantial number of providers, mainly physicians, who maintain Vermont licenses even though they do not practice in Vermont.

Information about the Vermont Health Care Provider Workforce Census, with links to annual reports, can be found here: http://healthvermont.gov/research/HlthCarePrvSrvys/HealthCareProviderSurveys.aspx

For more information about Health Care Provider Surveys, please contact:

Moshe Braner, Public Health Analyst

802-865-7703 or 800-869-2871

moshe.braner@vermont.gov

 

 

Vermont Area Health Education Centers (AHEC) Survey – Primary Care Workforce Summary Report

The Vermont Area Health Education Centers (AHEC) Program, in collaboration with many partners, improves access to quality health care through its focus on workforce development. Annually, each of the three community-based AHEC survey all primary care practices in its region. Reports are written every year as a compilation of the three regional surveys. Each annual report reflects a point-in-time and they are intended to supplement the comprehensive Vermont Health Care Provider Workforce Census conducted by the Vermont Department of Health, which occurs every two years during provider re-licensing.

Information about AHEC, with links to their annual survey reports, can be found here: http://www.uvm.edu/medicine/ahec/

For more information about the AHEC Survey, please contact:

Moshe Braner, Public Health Analyst

802-865-7703 or 800-869-2871

moshe.braner@vermont.gov

 

Analysis Geography

The Vermont Department of Health routinely uses three substate geographies: counties, Department of Health district office area, and hospital services areas. For most population health measures, there are too few respondents by town to allow appropriate statistical analysis. For this reason, data collected from residents of individual towns are aggregated to county, district, and hospital service areas.

 

Suggested Citations

Citing a specific data point:

Model: Vermont Department of Health. INDICATOR WORDING (GEOGRAPHY, DATA SOURCE, YEAR(S) OF DATA) in Healthy Vermonters 2020: “TOPIC”  Maps & Trends Vermont Health Indicators. Accessed DATE (E.G. TODAY). WEBLINK

Example: Vermont Department of Health. Percent of Vermonters with health insurance (Bennington County, Census – American Community Survey, 2009) in Healthy Vermonters 2020: “Access to Health Services”  Maps & Trends Vermont Health Indicators. Accessed 7/1/15. https://apps.health.vermont.gov/gis/ias/querytool/?topic=HealthyVermonters2020&theme1=AccesstoHealthServices

Citing the webpage more generally:

Model: Vermont Department of Health. Healthy Vermonters 2020: “TOPIC”  Maps & Trends Vermont Health Indicators, by GEOGRAPHY. Accessed DATE (E.G.TODAY). WEBLINK

Example: Vermont Department of Health. Healthy Vermonters 2020: “Access to Health Services”  Maps & Trends Vermont Health Indicators, by County. Accessed 7/1/15. https://apps.health.vermont.gov/gis/ias/querytool/?topic=HealthyVermonters2020&theme1=AccesstoHealthServices

Parenthetical citation within text:

Model: (Vermont Department of Health, DATA SOURCE, YEAR(S) OF DATA).

Example: (Vermont Department of Health, Census – American Community Survey, 2009).