Regional Epidemiology and the Medical Environment as It Pertains to Healthcare Quality and Outcomes Evaluation and Applicable Health Policy

While still evolving, healthcare evaluation in the United States is predominately analyzed via a model that examines the structures, processes, and outcomes of medical care. In order to provide a conceptual framework that better predicts health outcomes and more accurately reflects local healthcare, vested healthcare professionals can incorporate more relevant patient characteristics and the medical environment – which is here defined as the context in which the patient and healthcare system reside that has any health-related influences. To better appreciate why medical evaluation should include local environmental factors, this thesis demonstrates how common disease outcomes are regionally different across populous counties in Texas. Epidemiologic evidence from the Texas Department of State Health Services indicates that Alzheimer’s deaths, suicide rates, percent of preterm births, and rate of infant mortality significantly vary from county to county. Three medical environmental factors are then presented and discussed as examples typifying influences that warrant objective quantification because of their potential effect on health outcomes. Also presented is an illustrative case of how a specific county in Texas combined epidemiology, patient characteristics and the medical environment to evaluate healthcare and make appropriate health policy proposals for improvement. This thesis concludes with a summary of findings, suggested policy proposals, limitations and future questions.