Chronic Disease Burden and the Impact on Nursing Practice in South Texas

Sunday, 30 July 2017

Jean Dowling Dols, PhD
Mary M. Hoke, PhD
Karen L. Weis, PhD
M. Danielle Gunter, PhD
Ila Faye Miller School of Nursing & Health Professions, University of the Incarnate Word, San Antonio, TX, USA


Chronic diseases are the leading causes of death in the United States, with 45% of the population having at least one chronic disease.1 Americans aged 65+ with one or more chronic disease has risen from 86.9% in 1998 to 92.2% ten years later in 2008.2 The healthcare costs associated with treatment of chronic diseases accounts for almost 99% of the total Medicare spending and 83% of Medicaid spending.3 It is anticipated that by 2025, chronic diseases will affect about half of the population.3

Understanding the patterns of health and chronic disease burden by region is important in order to provide nurses appropriately prepared to address the regional issues of health and chronic illness. Today’s graduates are expected to understand broad concepts and assess evidence-based information rather than just memorize facts. Applying information and knowledge to specific nursing situations requires well-developed curriculum that aligns with local and regional individual and population health needs. Understanding the disease burden by region is essential to develop appropriate nursing curricula with pertinent exemplars for this unique patient and nursing population.4

The 43 South Texas counties included in the study’s region are predominately rural (n =28, 65%), with a substantial number considered border counties (n=17, 39.5%) on the U.S. border of Mexico.5 While the global burden of disease has been reported, the results primarily reflect 2010 data and do not provide a perspective of regional disease burden.6

The purpose of this study is to describe the scope and change in chronic disease burden across 43 counties in South Texas for a 10-year period in order to systematically assess health and chronic disease shifts to identify appropriate exemplars and continually assess and update nursing curriculum for a concept-based nursing curriculum.


De-identified data from the Texas Healthcare Information Collection (THCIC) will be used to determine the scope and the change in chronic disease burden across 43 counties in South Texas from 1st Quarter 2005 to 1st Quarter 2015.7 The THCIC database, built with healthcare data collected by the THCIC, a department within the Department of Health & Human Services (DSHS), was created in 1995 by the Texas Legislature.7 The data reports healthcare activity in Texas hospitals and health maintenance organizations. THCIC data contains the billing information for all inpatient admissions, excluding exempt facilities, including demographic data, hospital, admission/discharge information, payment information, principal and secondary diagnoses, E-codes, MS DRGs, charges, physician data, and a unique patient identifier. THCIC data also contains the emergency room utilization and charge procedure codes.

Hospitalizations for the disease codes of Diabetes, Coronary Artery Disease, COPD, arthritis, depression, cirrhosis, chronic kidney disease, respiratory tract infections, asthma, and stroke will be reviewed. Data will be exported from the THCIC database to SPSS version 21.

Descriptive statistics will be used to describe the disease categories. Differences between 2005 and 2015 disease burden by category will be analyzed with paired t-tests. Comparisons of disease burden with the presence of greater numbers of licensed nurses will be compared using parametric testing including Pearson's r.


Results are pending the completion of the data analysis in January 2017.


As schools of nursing struggle with increasing educational content requirements while also being urged to create seamless transitions to the workforce, there is a need for innovative approaches focused on the healthcare needs of the populations in which the students will most likely be immersed. This requires detailed knowledge and understanding of the chronic disease burden affecting the region in which the nursing schools reside. The results from this study will inform the faculty and administration of healthcare needs and priorities for the region. Exemplars for the 22 nursing programs in South Texas counties may then be focused on the change in disease burden.