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Dillard LK, Nelson-Bakkum ER, Walsh MC, Schultz A. Self-reported hearing loss is associated with poorer perceived health care access, timeliness, satisfaction, and quality: Findings from the Survey of the Health of Wisconsin. Disabil Health J 2023; 16:101394. [PMID: 36335067 DOI: 10.1016/j.dhjo.2022.101394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hearing loss is a highly prevalent chronic condition impacting communication and may negatively influence patients' health care experiences. OBJECTIVE Determine associations of hearing loss with perceived health care access, timeliness, satisfaction, and quality in a representative sample of the general population. METHODS The Survey of the Health of Wisconsin (SHOW) is a household-based examination survey that collects data from a representative sample of Wisconsin residents. SHOW participants from years 2008-2013 with data on self-reported hearing loss and health care access, timeliness, satisfaction, and quality were included in this study. Age- and sex- and multivariable-adjusted (additionally adjusted for race/ethnicity, education, marital status, public health region, smoking, chronic disease, self-reported health, and insurance coverage) logistic regression models were used to evaluate associations of hearing loss with participants' health care experiences. Results are presented as odds ratios (OR) with corresponding 95% confidence intervals. RESULTS There were 2438 individuals (42.1% men) included in this study with an average age of 48.3 (range 21-74; standard deviation [SD] 14.4) years. The number of participants who self-reported hearing loss was 642 (26.3%). After multivariable adjustment, hearing loss was associated with increased odds of perceived difficulties with health care access (OR 1.47 [1.05, 2.05]), timeliness (OR 1.69 [1.23, 2.32]), quality (OR 2.54 [1.50, 4.32]), and satisfaction (OR 2.50 [1.51, 4.13]). CONCLUSIONS Given the high prevalence of hearing loss and the growing aging population, there is an urgent need to prioritize interventions to improve health care provision for individuals with hearing loss.
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Affiliation(s)
- Lauren K Dillard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, USA.
| | - Erin R Nelson-Bakkum
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, USA
| | - Matthew C Walsh
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, USA
| | - Amy Schultz
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, USA
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2
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Walji S, Carroll JC, Haber C. Experiences of patients with a disability in receiving primary health care: Using experience-based design for quality improvement. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:517-524. [PMID: 34261715 DOI: 10.46747/cfp.6707517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To use patient-guided tours to gain insight into the experiences of patients with disabilities receiving primary care, with the goal of suggesting improvements. DESIGN A qualitative experience-based design study, using patient-guided tours. SETTING Multidisciplinary academic urban primary care practice. PARTICIPANTS Patients with disabilities identified by their health care providers. METHODS Patients walked through the clinic as they would on a "typical visit" describing their feelings and experiences. The investigator used a semistructured interview guide to prompt the patient. The tour was audiorecorded and transcribed. Thematic content analysis was used. MAIN FINDINGS Participants included 18 patients with various disabilities (physical disability, sensory disability, chronic illness, mental illness, learning disability, developmental disability). Strong positive relationships, particularly with the team and administrative staff, profoundly affected perceived access and experience of care. Multidirectional, clear, and respectful communication independently improved patients' experiences dramatically. Participants said that many access, coordination, and physical barriers were eased by team relationships and communication. Physical space and building issues were troublesome for those with physical and mental disabilities alike. Each participant's disability itself played a role in their experience but was not described as prominently as their relationship, communication, and spatial challenges. Participants described the patient-guided tour method as valuable to elicit experiences and feelings. CONCLUSION Some health care teams are unaware of how relationships and communication affect every aspect of health care for people with disabilities. Highlighting these findings with providers and organizations might prompt a more patient-centred model of care. Our experience-based design consisting of patient-guided tours was effective in assessing how those with disabilities experienced care.
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Affiliation(s)
- Sakina Walji
- Lecturer at the University of Toronto and a family physician in the Department of family Medicine at Mount Sinai Hospital, Sinai Health System, Toronto, Ont
| | - June C Carroll
- Professor, a clinician scientist, and Sydney G. Frankfort Chair in Family Medicine in the Department of Family and Community Medicine at the University of Toronto
| | - Cleo Haber
- Clinical social worker in the Department of Family Medicine at Mount Sinai Hospital
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3
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Pitrou I, Berbiche D, Vasiliadis HM. Mental health and satisfaction with primary care services in older adults: a study from the patient perspective on four dimensions of care. Fam Pract 2020; 37:459-464. [PMID: 32201895 DOI: 10.1093/fampra/cmaa019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Few studies have examined the association between mental health and satisfaction with primary care services in community-dwelling older adults. OBJECTIVE To examine the association between mental health in older adults and low satisfaction with primary care services within four dimensions of care. METHODS This secondary data analysis included 1624 older adults participating in the 'Étude sur la Santé des Aînés Services' (ESA-Services study) and recruited in primary care practices between 2011 and 2013 in the province of Quebec. Patient satisfaction and experience with care were assessed during face-to-face interviews with questions adapted from the Primary Care Assessment Survey. Self-reported mental health indicators included depression, anxiety, suicidal ideation, psychological distress and cognition. We conducted four logistic regressions to examine the associations between mental health and low satisfaction in the following dimensions of care: continuity of care, provider-patient interactions, adequacy of care and physical environment. RESULTS Nearly half of participants (48.5%) reported low satisfaction in at least one dimension of care examined. High psychological distress was associated with low satisfaction with provider-patient interactions [odds ratio (OR) = 1.02; 95% confidence interval (CI) = 1.00-1.04] and adequacy of care (OR = 1.04; 95% CI = 1.01-1.06). The presence of an anxiety disorder was associated with low satisfaction in adequacy of care (OR = 1.64; 95% CI = 1.00-2.72). Worse cognitive functioning was associated with low satisfaction in continuity of care, provider-patient interaction and adequacy of care. CONCLUSIONS Mental health was consistently associated with low satisfaction within dimensions of care. Results support the need for increased attention when delivering care to older adults with mental health problems.
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Affiliation(s)
- Isabelle Pitrou
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Department of Community Health Sciences, Charles-Le Moyne Innovations in Health Research Center CR-CSIS, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Djamal Berbiche
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Department of Community Health Sciences, Charles-Le Moyne Innovations in Health Research Center CR-CSIS, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Department of Community Health Sciences, Charles-Le Moyne Innovations in Health Research Center CR-CSIS, University of Sherbrooke, Longueuil, Quebec, Canada
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4
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Travers JL, Le C, Desai MM, Merrill JA. Factors Associated with Dissatisfaction in Medical Care Quality among Older Medicare Beneficiaries Suffering from Mental Illness. J Aging Soc Policy 2019; 33:51-66. [DOI: 10.1080/08959420.2019.1628624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jasmine L. Travers
- Postdoctoral Fellow, National Clinician Scholars Program, Yale Schools of Medicine and Nursing, New Haven, Connecticut, USA
| | - Cindy Le
- MPH Candidate, Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
| | - Mayur M. Desai
- Associate Professor of Epidemiology, Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jacqueline A. Merrill
- Professor of Nursing,Department of Biomedical Informatics at Columbia University Medical Center, Columbia University School of Nursing, New York, New York, USA
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5
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Rogan EL, Ranson CA, Mori TK, Park SK, Lam HM, Legaspi JF, Tran LK, Cameros CJM, Blackburn AN, Lee ST, Valle-Oseguera CS, Pham CN, Woelfel JA, Patel RA. Exploring the Valley of Savings: Minimizing Part D Costs and Optimizing Drug Therapy Outcomes in Medicare Beneficiaries With Developmental Disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:234-241. [PMID: 31120407 DOI: 10.1352/1934-9556-57.3.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Nonelderly disabled Medicare beneficiaries have a higher prevalence of chronic conditions, higher utilization of prescription medications, and increased demand for clinical services when compared to beneficiaries 65 years of age and older who are not disabled. Out-of-pocket costs and medication-related problems are major barriers to medication compliance and achievement of therapeutic goals. A school of pharmacy partnered with a nonprofit organization that provides care to individuals with developmental disabilities. The present study highlights outcomes resulting from (a) providing Medicare Part D plan optimization services to lower prescription drug costs and (b) Medication Therapy Management services to evaluate safe and effective medication use in this beneficiary population. Provided interventions were shown to reduce overall medication costs and identify significant medication-related problems.
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Affiliation(s)
- Edward L Rogan
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Carly A Ranson
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Traci K Mori
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Salley K Park
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Howard M Lam
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Jamie F Legaspi
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Lan Kim Tran
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Christine Julie M Cameros
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Amy Natsuki Blackburn
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Sandra T Lee
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Cynthia S Valle-Oseguera
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Christopher N Pham
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Joseph A Woelfel
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
| | - Rajul A Patel
- Edward L. Rogan, Carly A. Ranson, Traci K. Mori, Salley K. Park, Howard M. Lam, Jamie F. Legaspi, Lan Kim Tran, Christine Julie M. Cameros, Amy Natsuki Blackburn, Sandra T. Lee, Cynthia S. Valle-Oseguera, Christopher N. Pham, Joseph A. Woelfel, and Rajul A. Patel, University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA
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6
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Bernal OA, McClintock HF, Kurichi JE, Kwong PL, Xie D, Streim JE, Pezzin LE, Bogner HR. Patient Satisfaction and Perceived Quality of Care Among Younger Medicare Beneficiaries According to Activity Limitation Stages. Arch Phys Med Rehabil 2019; 100:289-299. [PMID: 30316959 DOI: 10.1016/j.apmr.2018.09.114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/19/2018] [Accepted: 09/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the association between activity limitation stages and patient satisfaction and perceived quality of medical care among younger Medicare beneficiaries. DESIGN Cross-sectional study. SETTING Medicare Current Beneficiary Survey (MCBS) for calendar years 2001-2011. PARTICIPANTS A population-based sample (N=9323) of Medicare beneficiaries <65 years of age living in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physician (PCP), interpersonal skills of PCP, and quality of information provided by PCP. Persons were classified into an activity limitation stage (0-IV) which was derived from self-reported difficulty performing activities of daily living (ADL) and instrumental activities of daily living (IADL). RESULTS Compared to beneficiaries with no limitations at ADL stage 0, the adjusted odds ratios (95% confidence intervals) for stage I (mild) to stage IV (complete) for satisfaction with access barriers ranged from 0.62 (0.53-0.72) at stage I to a minimum of 0.31 (0.22-0.43) at stage IV. Similarly, compared to beneficiaries at IADL stage 0, satisfaction with access barriers ranged from 0.66 (0.55-0.79) at stage I to a minimum of 0.36 (0.26-0.51) at stage IV. Satisfaction with care coordination and quality and perceived quality of medical care were not associated with activity limitation stages. CONCLUSIONS Younger Medicare beneficiaries with disabilities reported decreased satisfaction with access to medical care, highlighting the need to improve access to health care and human services and to enhance workforce capacity to meet the needs of this patient population.
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Affiliation(s)
- Olivia A Bernal
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Heather F McClintock
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA
| | - Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pui L Kwong
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and VISN 4 Mental Illness Research Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA
| | - Liliana E Pezzin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Hillary R Bogner
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Family Medicine and Community Health, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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7
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Lala D, Houghton PE, Kras-Dupuis A, Wolfe DL. Developing a Model of Care for Healing Pressure Ulcers With Electrical Stimulation Therapy for Persons With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 22:277-287. [PMID: 29339869 DOI: 10.1310/sci2204-277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Electrical stimulation therapy (EST) has been shown to be an effective therapy for managing pressure ulcers in individuals with spinal cord injury (SCI). However, there is a lack of uptake of this therapy, and it is often not considered as a first-line treatment, particularly in the community. Objective: To develop a pressure ulcer model of care that is adapted to the local context by understanding the perceived barriers and facilitators to implementing EST, and to describe key initial phases of the implementation process. Method: Guided by the Knowledge-to-Action (KTA) and National Implementation Research Network (NIRN) frameworks, a community-based participatory research (CBPR) approach was used to complete key initial implementation processes including (a) defining the practice, (b) identifying the barriers and facilitators to EST implementation and organizing them into implementation drivers, and (c) developing a model of care that is adapted to the local environment. Results: A model of care for healing pressure ulcers with EST was developed for the local environment while taking into account key implementation barriers including lack of interdisciplinary collaboration and communication amongst providers between and across settings, inadequate training and education, and lack of resources, such as funding, time, and staff. Conclusions: Using established implementation science frameworks with structured planning and engaging local stakeholders are important exploratory steps to achieve a successful sustainable best practice implementation project.
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Affiliation(s)
- D Lala
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - P E Houghton
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,School of Physical Therapy, Western University, London, Ontario
| | | | - D L Wolfe
- Parkwood Institute, London, Ontario, Canada
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8
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Health care access and quality for persons with disability: Patient and provider recommendations. Disabil Health J 2017; 11:382-389. [PMID: 29325927 DOI: 10.1016/j.dhjo.2017.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 12/09/2017] [Accepted: 12/27/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Significant disparities in health care access and quality persist between persons with disabilities (PWD) and persons without disabilities (PWOD). Little research has examined recommendations of patients and providers to improve health care for PWD. OBJECTIVE We sought to explore patient and health care provider recommendations to improve health care access and quality for PWD through focus groups in the physical world in a community center and in the virtual world in an online community. METHODS In all, 17 PWD, 4 PWOD, and 6 health care providers participated in 1 of 5 focus groups. Focus groups were conducted in the virtual world in Second Life® with Virtual Ability, an online community, and in the physical world at Agape Community Center in Milwaukee, WI. Focus group data were analyzed using a grounded theory methodology. RESULTS Themes that emerged in focus groups among PWD and PWOD as well as health care providers to improve health care access and quality for PWD were: promoting advocacy, increasing awareness and knowledge, improving communication, addressing assumptions, as well as modifying and creating policy. Many participants discussed political empowerment and engagement as central to health care reform. CONCLUSIONS Both PWD and PWOD as well as health care providers identified common themes potentially important for improving health care for PWD. Patient and health care provider recommendations highlight a need for modification of current paradigms, practices, and approaches to improve the quality of health care provision for PWD. Participants emphasized the need for greater advocacy and political engagement.
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Abstract
BACKGROUND Physician care influences patient satisfaction. Inherent physician attributes may also affect scores. OBJECTIVE To determine the relationship between physician characteristics and patient satisfaction regarding physician care and communication. METHOD Observational retrospective study. We examined patient satisfaction surveys from inpatient adults across 9 questions (HCAHPS: Courtesy, Listen, and Explain; Press Ganey: Time, Concern, Informed, Friendliness, Skill, Rating) in relation to physician gender, age, ethnicity, race, and specialty. RESULTS We analyzed 51 896 surveys on 914 physicians. In univariate analysis, males were rated significantly more often in the highest category (top box) compared to females on Informed and Skill, and whites were rated in the top box more often than nonwhites on all questions. In multivariate analysis, there were no significant associations between ratings and physician gender, ethnicity, and race. On all questions, the odds of being rated in the top box were highest for obstetricians, second highest for surgeons, and lowest for medicine providers. On the question of Skill, the odds of being rated in the top box were higher with increasing age. CONCLUSION Patient satisfaction regarding physicians is associated with physician specialty and age.
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Affiliation(s)
- J Gene Chen
- Department of Pediatrics, University of Florida College of Medicine, Orlando, FL, USA
- Arnold Palmer Hospital for Children, Orlando Health, Orlando, FL, USA
| | - Baiming Zou
- Department of Biostatistics, Colleges of Medicine and Public Health, University of Florida, Gainesville, FL, USA
| | - Jonathan Shuster
- Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville, FL, USA
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10
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Garg R, Shen C, Sambamoorthi N, Kelly K, Sambamoorthi U. Type of Multimorbidity and Patient-Doctor Communication and Trust among Elderly Medicare Beneficiaries. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2016; 2016:8747891. [PMID: 27800181 PMCID: PMC5069353 DOI: 10.1155/2016/8747891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/01/2016] [Accepted: 09/15/2016] [Indexed: 06/06/2023]
Abstract
Background. Effective communication and high trust with doctor are important to reduce the burden of multimorbidity in the rapidly aging population of the US. However, the association of multimorbidity with patient-doctor communication and trust is unknown. Objective. We examined the relationship between multimorbidity and patient-doctor communication and trust among the elderly. Method. We used the Medicare Current Beneficiary Survey (2012) to analyze the association between multimorbidity and patient-doctor communication and trust with multivariable logistic regressions that controlled for patient's sociodemographic characteristics, health status, and satisfaction with care. Results. Most elderly beneficiaries reported effective communication (87.5-97.5%) and high trust (95.4-99.1%) with their doctors. The elderly with chronic physical and mental conditions were less likely than those with only physical conditions to report effective communication with their doctor (Adjusted Odds Ratio [95% Confidence Interval] = 0.80 [0.68, 0.96]). Multimorbidity did not have a significant association with patient-doctor trust. Conclusions. Elderly beneficiaries had high trust in their doctors, which was not affected by the presence of multimorbidity. Elderly individuals who had a mental condition in addition to physical conditions were more likely to report ineffective communication. Programs to improve patient-doctor communication with patients having cooccurring chronic physical and mental health conditions may be needed.
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Affiliation(s)
- Rahul Garg
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA
| | - Chan Shen
- Department of Biostatistics and Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nethra Sambamoorthi
- School of Continuing Education, Northwestern University, Evanston, IL 60208, USA
| | - Kimberly Kelly
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV 26506, USA
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11
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Na L, Hennessy S, Bogner HR, Kurichi JE, Stineman M, Streim JE, Kwong PL, Xie D, Pezzin LE. Disability stage and receipt of recommended care among elderly medicare beneficiaries. Disabil Health J 2016; 10:48-57. [PMID: 27765676 DOI: 10.1016/j.dhjo.2016.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/25/2016] [Accepted: 09/28/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Receipt of recommended care among older adults is generally low. Findings regarding service use among persons with disabilities supports the notion of disparities but provides inconsistent evidence of underuse of recommended care. OBJECTIVE To examine the extent to which receipt of recommended care among older Medicare beneficiaries varies by disability status, using a newly developed staging method to classify individuals according to disability. METHODS In a cohort study, we included community-dwelling Medicare beneficiaries aged 65 and older who participated in the Medicare Current Beneficiary Survey between 2001 and 2008. Logistic regression modeling assessed the association of receiving recommended care on 38 indicators across different activity limitation stages. RESULTS Nearly one out of every three elderly Medicare beneficiaries did not receive overall recommended care. Adjusted odds ratios (ORs) revealed a decrease in use of recommended care with increasing activity limitation stage. For instance, ORs (95% CIs) across mild, moderate, severe and complete limitation stages (stages I-IV) compared to no limitation (stage 0) in ADLs were 0.99 (0.94-1.05), 0.89 (0.83-0.95), 0.81 (0.75-0.89) and 0.56 (0.46-0.68). Disparities in receipt of recommended care by disability stage were most marked for care related to post-hospitalization follow-up and, to a lesser degree, care of chronic conditions and preventive care. CONCLUSIONS Elderly beneficiaries at higher activity limitation stages experienced substantial disparities in receipt of recommended care. Tailored interventions may be needed to reduce disparities in receipt of recommended medical care in this population.
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Affiliation(s)
- Ling Na
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA, USA
| | - Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Margaret Stineman
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pui L Kwong
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Liliana E Pezzin
- Center for Patient Care and Outcomes Research (PCOR), Medical College of Wisconsin, Milwaukee, WI, USA; Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Bogner HR, de Vries McClintock HF, Kurichi JE, Kwong PL, Xie D, Hennessy S, Streim JE, Stineman MG. Patient Satisfaction and Prognosis for Functional Improvement and Deterioration, Institutionalization, and Death Among Medicare Beneficiaries Over 2 Years. Arch Phys Med Rehabil 2016; 98:1-10. [PMID: 27590442 DOI: 10.1016/j.apmr.2016.07.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine how patient satisfaction with care coordination and quality and access to medical care influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death among older adults. DESIGN National representative sample with 2-year follow-up. SETTING Medicare Current Beneficiary Survey from calendar years 2001 to 2008. PARTICIPANTS Community-dwelling adults (N=23,470) aged ≥65 years followed for 2 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A multinomial logistic regression model taking into account the complex survey design was used to examine the association between patient satisfaction with care coordination and quality and patient satisfaction with access to medical care and activities of daily living (ADL) stage transitions, institutionalization, or death after 2 years, adjusting for baseline socioeconomics and health-related characteristics. RESULTS Out of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained stable in ADL stage, 2508 (10.7% weighted) improved, 3210 (13.3% weighted) deteriorated, 582 (2.5% weighted) were institutionalized, and 2281 (9.7% weighted) died. Beneficiaries who were in the top quartile of satisfaction with care coordination and quality were less likely to be institutionalized (adjusted relative risk ratio [RRR], .68; 95% confidence interval [CI], .54-.86). Beneficiaries who were in the top quartile of satisfaction with access to medical care were less likely to functionally deteriorate (adjusted RRR, .87; 95% CI, .79-.97), be institutionalized (adjusted RRR, .72; 95% CI, .56-.92), or die (adjusted RRR, .86; 95% CI, .75-.98). CONCLUSIONS Knowledge of patient satisfaction with medical care and risk of functional deterioration may be helpful for monitoring and addressing disability-related health care disparities and the effect of ongoing policy changes among Medicare beneficiaries.
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Affiliation(s)
- Hillary R Bogner
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Heather F de Vries McClintock
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jibby E Kurichi
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pui L Kwong
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Margaret G Stineman
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Niefeld MR, Kasper JD. Access to Ambulatory Medical and Long-Term Care Services Among Elderly Medicare and Medicaid Beneficiaries: Organizational, Financial, and Geographic Barriers. Med Care Res Rev 2016; 62:300-19. [PMID: 15894706 DOI: 10.1177/1077558705275418] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The comprehensive insurance coverage afforded low-income elders with both Medicare and Medicaid coverage (dual enrollees) has substantially reduced financial barriers to care. However, other studies show reduced and less appropriate utilization patterns among dual enrollees compared to Medicare beneficiaries with private supplemental insurance, suggesting access barriers remain. This study found that 59 percent of elderly dual enrollees needed an ambulatory medical or long-term care service in a 1-year period. One third of these individuals experienced barriers to access; organizational and geographic barriers were more prevalent than financial barriers. African American race, trouble paying basic living expenses, fair or poor health status, and an unfavorable assessment of physician information giving were significantly associated with an increased likelihood of organizational and geographic access barriers among elderly dual enrollees.
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14
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Sandstrom R, Bruns A. Disparities in Access to Outpatient Rehabilitation Therapy for African Americans with Arthritis. J Racial Ethn Health Disparities 2016; 4:599-606. [DOI: 10.1007/s40615-016-0263-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 11/28/2022]
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Pourat N, Kagawa-Singer M, Wallace SP. Are Managed Care Medicare Beneficiaries With Chronic Conditions Satisfied With Their Care? J Aging Health 2016; 18:70-90. [PMID: 16470968 DOI: 10.1177/0898264305280997] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This article compares patient experiences of chronically ill older people in health maintenance organizations (HMOs) with other forms of Medicare supplemental coverage. METHOD Using data from the 1996 Medicare Current Beneficiaries Survey, the authors analyzed the experiences of chronically ill elderly with overall quality, access to care, and physicians' technical, interpersonal, and information-giving skills. Logistic models controlled for prevalent chronic conditions, functioning, perceived health status, sociodemographics, region of residence, and county-level Medicare HMO penetration. RESULTS Satisfaction with quality of overall care and physicians' skills was more likely for many conditions for those with private fee for service and Medicaid supplemental coverage, compared to Medicare HMO population. No insurance effects were found among elders who had none of the examined conditions. DISCUSSION Managed care may have negatively affected patients' perceptions of overall quality of care and doctor-patient interaction. Including additional and supplementary services to the delivery of care may improve satisfaction rates.
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Bogner HR, de Vries McClintock HF, Hennessy S, Kurichi JE, Streim JE, Xie D, Pezzin LE, Kwong PL, Stineman MG. Patient Satisfaction and Perceived Quality of Care Among Older Adults According to Activity Limitation Stages. Arch Phys Med Rehabil 2015; 96:1810-9. [PMID: 26119464 PMCID: PMC4758213 DOI: 10.1016/j.apmr.2015.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/14/2015] [Accepted: 06/02/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine whether patient satisfaction and perceived quality of medical care are related to stages of activity limitations among older adults. DESIGN Cross-sectional study. SETTING Medicare Current Beneficiary Survey (MCBS) for calendar years 2001 to 2011. PARTICIPANTS A population-based sample (N=42,584) of persons aged ≥65 years living in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physicians, interpersonal skills of primary care physicians, and quality of information provided by primary care physicians. Persons were classified into a stage of activity limitation (0-IV) derived from self-reported difficulty levels performing activities of daily living (ADL) and instrumental ADL. RESULTS Compared with older beneficiaries with no limitations at ADL stage 0, the adjusted odds ratios (ORs) for stage I (mild) to stage III (severe) for satisfaction with care coordination and quality ranged from .85 (95% confidence interval [CI], .80-.92) to .79 (95% CI, .70-.89). Compared with ADL stage 0, satisfaction with access barriers ranged from OR=.81 (95% CI, .76-.87) at stage I to a minimum of OR=.67 (95% CI, .59-.76) at stage III. Similarly, compared with older beneficiaries at ADL stage 0, perceived quality of the technical skills of their primary care physician ranged from OR=.87 (95% CI, .82-.94) at stage I to a minimum of OR=.81 (95% CI, .72-.91) at stage III. CONCLUSIONS Medicare beneficiaries at higher stages of activity limitation, although not necessarily the highest stage of activity limitation, reported less satisfaction with medical care.
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Affiliation(s)
- Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Heather F de Vries McClintock
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA
| | - Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; VISN 4 Mental Illness Research Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Liliana E Pezzin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Pui L Kwong
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Margaret G Stineman
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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de Vries McClintock HF, Barg FK, Katz SP, Stineman MG, Krueger A, Colletti PM, Boellstorff T, Bogner HR. Health care experiences and perceptions among people with and without disabilities. Disabil Health J 2015; 9:74-82. [PMID: 26482010 DOI: 10.1016/j.dhjo.2015.08.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about health care experiences among people with and without disabilities. OBJECTIVE We sought to explore perceptions of people with and without disabilities related to their health care experiences. METHODS Nineteen persons with and without disabilities participated in one of four focus groups. Focus groups were conducted in the physical world in Milwaukee, WI and in the virtual world in Second Life(®) with Virtual Ability, a well-established community designed by and for people with a wide range of disabilities. A grounded theory methodology was employed to analyze focus group data. Inclusion of physical and virtual world focus groups enabled people with a wide range of disabilities to participate. RESULTS While some participants described instances of receiving good care, many discussed numerous barriers. The main themes that emerged in focus groups among both persons with and without disabilities related to their health care experiences including poor coordination among providers; difficulties with insurance, finances, transportation and facilities; short duration of visits with physicians; inadequate information provision; feelings of being diminished and deflated; and self-advocacy as a tool. Transportation was a major concern for persons with disabilities influencing mobility. Persons with disabilities described particularly poignant experiences wherein they felt invisible or were viewed as incompetent. CONCLUSIONS Both persons with and without disabilities experienced challenges in obtaining high quality health care. However, persons with disabilities experienced specific challenges often related to their type of disability. Participants stressed the need for improving health care coordination and the importance of self-advocacy.
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Affiliation(s)
- Heather F de Vries McClintock
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Frances K Barg
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA; Mixed Methods Research Lab, University of Pennsylvania, Philadelphia, PA, USA
| | - Sam P Katz
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA; Mixed Methods Research Lab, University of Pennsylvania, Philadelphia, PA, USA
| | - Margaret G Stineman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Tom Boellstorff
- Department of Anthropology, University of California, Irvine, CA, USA
| | - Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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18
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Horner-Johnson W, Dobbertin K, Lee JC, Andresen EM. Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey. Health Serv Res 2014; 49:1980-99. [PMID: 24962662 DOI: 10.1111/1475-6773.12195] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine differences in access to health care and receipt of clinical preventive services by type of disability among working-age adults with disabilities. DATA SOURCE Secondary analysis of Medical Expenditure Panel Survey (MEPS) data from 2002 to 2008. STUDY DESIGN We conducted cross-sectional logistic regression analyses comparing people with different types of disabilities on health insurance status and type; presence of a usual source of health care; delayed or forgone care; and receipt of dental checkups and cancer screening. DATA COLLECTION We pooled annualized MEPS data files across years. Our analytic sample consisted of adults (18-64 years) with physical, sensory, or cognitive disabilities and nonmissing data for all variables of interest. PRINCIPAL FINDINGS Individuals with hearing impairment had better health care access and receipt than people with other disability types. People with multiple types of limitations were especially likely to have health care access problems and unmet health care needs. CONCLUSIONS There are differences in health care access and receipt of preventive care depending on what type of disability people have. More in-depth research is needed to identify specific causes of these disparities and assess interventions to address health care barriers for particular disability groups.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health and Science University, Portland, OR
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19
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Barnett DD, Koul R, Coppola NM. Satisfaction with health care among people with hearing impairment: a survey of Medicare beneficiaries. Disabil Rehabil 2013; 36:39-48. [PMID: 23594058 DOI: 10.3109/09638288.2013.777803] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study was to investigate the determinants of access to and satisfaction with health care from Medicare participants with hearing impairment. METHOD Raw data for the study was obtained from the 2004 Medicare Current Beneficiary Survey (MCBS). Satisfaction with care was assessed using 10 of the MCBS questions probing satisfaction in a number of areas related to health care. The data were analyzed using logistic regression. This analysis was conducted in three steps. The first step involved identifying potentially important predisposing and enabling variables that influenced satisfaction with care using univariate analysis. The second step involved fitting the variables retained from the first step into a multiple logistic regression equation to determine a preliminary main effects model. The final analysis included determining the odds ratio for each independent variable retained from the earlier analysis. RESULTS Individuals with hearing impairment demonstrated some level of dissatisfaction with quality of health care. Each of the MCBS satisfaction questions were significantly (p < 0.05) associated with at least one of the communication variables. CONCLUSIONS Understanding the effects of hearing impairment on satisfaction with health care is critical to the delivery of effective and efficient services to individuals with such disabilities. IMPLICATIONS FOR REHABILITATION Presence of communication impairment, specifically hearing impairment, affects satisfaction with health care. Medical school training regarding methods to improve diagnosis and treatment of patients with communicative impairments could lead to improved patient-provider interactions and ultimately increased satisfaction with the provider and care given. Health care providers need to allow for extended appointments for patients with communication impairments. Time accommodations could prevent misunderstandings about diagnosis and treatment methods which otherwise might have detrimental results.
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Affiliation(s)
- Denise Derrick Barnett
- Department of Communication Sciences and Disorders, Abilene Christian University , Abilene, TX , USA
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20
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Use of outpatient care in VA and Medicare among disability-eligible and age-eligible veteran patients. BMC Health Serv Res 2012; 12:51. [PMID: 22390389 PMCID: PMC3359202 DOI: 10.1186/1472-6963-12-51] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 03/05/2012] [Indexed: 11/16/2022] Open
Abstract
Background More than half of veterans who use Veterans Health Administration (VA) care are also eligible for Medicare via disability or age, but no prior studies have examined variation in use of outpatient services by Medicare-eligible veterans across health system, type of care or time. Objectives To examine differences in use of VA and Medicare outpatient services by disability-eligible or age-eligible veterans among veterans who used VA primary care services and were also eligible for Medicare. Methods A retrospective cohort study of 4,704 disability- and 10,816 age-eligible veterans who used VA primary care services in fiscal year (FY) 2000. We tracked their outpatient utilization from FY2001 to FY2004 using VA administrative and Medicare claims data. We examined utilization differences for primary care, specialty care, and mental health outpatient visits using generalized estimating equations. Results Among Medicare-eligible veterans who used VA primary care, disability-eligible veterans had more VA primary care visits (p < 0.001) and more VA specialty care visits (p < 0.001) than age-eligible veterans. They were more likely to have mental health visits in VA (p < 0.01) and Medicare-reimbursed visits (p < 0.01). Disability-eligible veterans also had more total (VA+Medicare) visits for primary care (p < 0.01) and specialty care (p < 0.01), controlling for patient characteristics. Conclusions Greater use of primary care and specialty care visits by disability-eligible veterans is most likely related to greater health needs not captured by the patient characteristics we employed and eligibility for VA care at no cost. Outpatient care patterns of disability-eligible veterans may foreshadow care patterns of veterans returning from Afghanistan and Iraq wars, who are entering the system in growing numbers. This study provides an important baseline for future research assessing utilizations among returning veterans who use both VA and Medicare systems. Establishing effective care coordination protocols between VA and Medicare providers can help ensure efficient use of taxpayer resources and high quality care for disabled veterans.
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Escribano-Hernández A, García-Garraus JM, Hernández-García I. Evaluation of satisfaction among relatives of mentally disabled patients who were users of a dental care protocol under general anaesthesia. Med Oral Patol Oral Cir Bucal 2012; 17:e83-8. [PMID: 21743429 PMCID: PMC3448194 DOI: 10.4317/medoral.17069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 01/21/2011] [Indexed: 11/22/2022] Open
Abstract
Objectives: In the field of action of disease associated with dependence the Third Health Plan of Castilla y León
aims specifically at promoting the adjustment of health assistance to the needs of disabled people, according to
their situation.
Our objectives were:
General: To know the satisfaction level among relatives or caregivers of people who were treated according to a protocol
of dental care for mentally disabled people.
Specific: To know if satisfaction is related to any sociodemographic characteristics of patients or to their pathology.
Study design: Cross-sectional study by telephone survey, set in the Primary Health Area of Salamanca.
The target population includes relatives or caregivers of mentally disabled patients who were sent to the hospital
for treatment under general anaesthesia after being attended in Primary Dental Care Units, from 1st of June/2005
to 31st of May/2006.
Social and demographic variables and patients’ diseases, as well as level of satisfaction with the service, were
studied through a survey.
Results: 67.4% of patients’ relatives or caregivers answered the survey, among whom 94.7% (C.I. 95%: 89-100%)
were quite or very satisfied with the service in general.
Conclusion:The protocol has high acceptance despite its difficulties and it has achieved considerable improvements
in several aspects of patients’ life. This level of satisfaction was not related to any sociodemographic or
clinical patient characteristics.
Nevertheless, accessibility aspects and communication with patients may still be improved. Key words: Health care surveys, dental care for disabled, patient satisfaction.
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Pandhi N, Schumacher JR, Barnett S, Smith MA. Hearing loss and older adults' perceptions of access to care. J Community Health 2011; 36:748-55. [PMID: 21301940 DOI: 10.1007/s10900-011-9369-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We investigated whether hard-of-hearing older adults were more likely to report difficulties and delays in accessing care and decreased satisfaction with healthcare access than those without hearing loss. The Wisconsin Longitudinal Study (2003-2006 wave, N = 6,524) surveyed respondents regarding hearing, difficulties/delays in accessing care, satisfaction with healthcare access, socio-demographics, chronic conditions, self-rated health, depression, and length of relationship with provider/site. We used multivariate regression to compare access difficulties/delays and satisfaction by respondents' hearing status (hard-of-hearing or not). Hard-of-hearing individuals comprised 18% of the sample. Compared to those not hard-of-hearing, hard-of-hearing individuals were significantly more likely to be older, male and separated/divorced. They had a higher mean number of chronic conditions, including atherosclerotic vascular disease, diabetes and depression. After adjustment for potential confounders, hard-of-hearing individuals were more likely to report difficulties in accessing healthcare (Odds Ratio 1.85; 95% Confidence Interval 1.19-2.88). Satisfaction with healthcare access was similar in both groups. Our findings suggest healthcare access difficulties will be heightened for more of the population because of the increasing prevalence of hearing loss. The prevalence of hearing loss in this data is low and our findings from a telephone survey likely underestimate the magnitude of access difficulties experienced by hard-of-hearing older adults. Further research which incorporates accessible surveys is needed. In the meantime, clinicians should pay particular attention to assessing barriers in healthcare access for hard-of-hearing individuals. Resources should be made available to proactively address these issues for those who are hard-of-hearing and to educate providers about the specific needs of this population.
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Affiliation(s)
- Nancy Pandhi
- Department of Family Medicine, University of Wisconsin, Madison, WI 53705, USA.
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Gulley SP, Rasch EK, Chan L. The complex web of health: relationships among chronic conditions, disability, and health services. Public Health Rep 2011; 126:495-507. [PMID: 21800744 PMCID: PMC3115209 DOI: 10.1177/003335491112600406] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES A critical issue in health-care reform concerns how to realign health-care delivery systems to manage medical care services for people with ongoing and costly needs for care. We examined the overlapping health-care needs of two such population groups among the U.S. working-age population (those aged 18-64 years): people with chronic medical conditions and people with disabilities. METHODS Using the Medical Expenditure Panel Survey (2002-2004), we examined differences in health status, service use, and access to care among and between working-age adults reporting disabilities and/or one or more chronic conditions. We also analyzed people with three key chronic conditions: arthritis, diabetes, and depression. RESULTS More than half of working-age people with disabilities reported having more than one chronic condition. Among those with activities of daily living or instrumental activities of daily living limitations, 35% reported four or more chronic conditions at a time. We found considerable variability in access problems and service use depending on how we accounted for the overlap of multiple conditions among people with arthritis, diabetes, and depression. However, disability consistently predicted higher emergency department use, higher hospitalization rates, and greater access problems. CONCLUSIONS The overall prevalence of chronic conditions among the U.S. working-age population, coupled with the high concentration of multiple chronic conditions among those with disabilities, underscores the importance of reforming health-care delivery systems to provide person-centered care over time. New policy-relevant measures that transcend diagnosis are required to track the ongoing needs for health services that these populations present.
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Affiliation(s)
- Stephen P Gulley
- National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Building 10, CRC, Room 1-1469, 10 Center Dr., MSC-1604, Bethesda, MD 20892-1604, USA.
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Hoffman JM, Ciol MA, Huynh M, Chan L. Estimating transition probabilities in mobility and total costs for medicare beneficiaries. Arch Phys Med Rehabil 2011; 91:1849-55. [PMID: 21112425 DOI: 10.1016/j.apmr.2010.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 08/06/2010] [Accepted: 08/17/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine how persons move back and forth along levels of mobility disability. DESIGN Self-reported mobility limitations were used to create categories of annual transition states. The total cost to Medicare associated with each year was calculated for each participant. In addition, we examined cost relative to transition state, adjusting for demographic and other health status variables. SETTING National survey. PARTICIPANTS Participants in the longitudinal Medicare Current Beneficiary Survey from 1992 to 2005. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Annual self-reported mobility limitations and total Medi costs. RESULTS Most participants remained without mobility limitations or improved over time. Reported average costs were 10 times higher for those who transitioned to severe limitations, unable to walk, or death compared with persons who reported no mobility limitation. Estimated costs were highest for those transitioning to increased states of disability and to death. CONCLUSIONS Mobility limitations in older adults are dynamic, and improvement (as measured by annual transitions) occurred for a large number of Medicare beneficiaries. High total annual costs were observed in groups that transitioned to worsening mobility states, suggesting a link between mobility limitation transitions and cost. Prevention and treatment of mobility limitation may be an important factor to consider in health care reform.
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Affiliation(s)
- Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, 98195-6490, USA.
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Gulley SP, Rasch EK, Chan L. Ongoing coverage for ongoing care: access, utilization, and out-of-pocket spending among uninsured working-aged adults with chronic health care needs. Am J Public Health 2010; 101:368-75. [PMID: 21164090 DOI: 10.2105/ajph.2010.191569] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine how part-year and full-year gaps in health insurance coverage affected working-aged persons with chronic health care needs. METHODS We conducted multivariate analyses of the 2002-2004 Medical Expenditure Panel Survey to compare access, utilization, and out-of-pocket spending burden among key groups of persons with chronic conditions and disabilities. The results are generalizable to the US community-dwelling population aged 18 to 64 years. RESULTS Among 92 million adults with chronic conditions, 21% experienced at least 1 month uninsured during the average year (2002-2004). Among the 25 million persons reporting both chronic conditions and disabilities, 23% were uninsured during the average year. These gaps in coverage were associated with significantly higher levels of access problems, lower rates of ambulatory visits and prescription drug use, and higher levels of out-of-pocket spending. CONCLUSIONS Implementation of health care reform must focus not only on the prevention of chronic conditions and the expansion of insurance coverage but also on the long-term stability of the coverage to be offered.
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Affiliation(s)
- Stephen P Gulley
- National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Building 10 CRC, Room 1-1469, 10 Center Drive, MSC 1604, Bethesda, MD 20892-1604, USA.
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Abstract
Given the numerous quality improvement (QI) initiatives that have been undertaken in various medical fields, it is clear that inpatient rehabilitation services, particularly those geared toward stroke rehabilitation, can also benefit from these programs. To effectively evaluate the quality of rehabilitation services, indicators measuring structure, process, and outcomes must be included as part of any QI initiative. In addition to measuring quality, these indicators can be used to describe and address disparities in the provision of rehabilitation services on the basis of race, socioeconomic status, geography, disability status, and a multitude of other demographic factors. To improve quality and address health disparities associated with stroke rehabilitation, QI initiatives must be scientifically driven, continuing the trend of evidence-based practice in medicine. They must also remain flexible, because the science of quality improvement is an ever-changing field. It will be a challenge to convince physicians and other health care professionals that QI initiatives are a worthwhile investment of their limited time and resources, and further research is required to move the field of quality in stroke rehabilitation forward.
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Affiliation(s)
- Nizar Dowla
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
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Gal I, Weisberg-Yosub P, Shavit M, Doron I. Complaints on Health Services: A Survey of Persons With Disabilities. JOURNAL OF DISABILITY POLICY STUDIES 2010. [DOI: 10.1177/1044207310385685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the extent to which people with disabilities express their voices and present complaints about the quality of health services, and how their complaints are submitted, compared to nondisabled persons. Data were collected via two national surveys from 243 people with disabilities and 956 nondisabled respondents in Israel who perceived themselves to be aggrieved by their health providers. People with disabilities complained only slightly more often than nondisabled persons, and the majority of complaints were submitted locally and informally by both groups. Since people with disabilities use health services more frequently than nondisabled persons, the fact that a majority of customers with disabilities remains silent causes the health system to lose important information regarding areas for redress or for service recovery. The results have implications for needed actions by health providers and outreach efforts by advocacy groups as well as for further policy and research directions that can improve the quality of health services to people with disabilities.
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Affiliation(s)
- Iddo Gal
- University of Haifa, Haifa, Israel,
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28
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Gibson J, O'Connor R. Access to health care for disabled people: a systematic review. ACTA ACUST UNITED AC 2010. [DOI: 10.5042/scn.2010.0599] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Järvelin J, Rosenqvist G, Häkkinen U, Sintonen H. Patient and hospital characteristics associated with claims and compensations for patient injuries in coronary artery bypass grafting in Finland. J Health Serv Res Policy 2009; 14:150-5. [PMID: 19541873 DOI: 10.1258/jhsrp.2008.008084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To analyse the association between individual patients' risk factors and rates of claims and compensations for patient injuries in an insurance scheme in which proof of negligence is not required. And to explore whether either hospital productivity or volume of procedures is related to claims and compensation rates. METHODS A two-step sequential logistic regression was applied on data collected from administrative registers. It included 17,834 patients who had undergone coronary artery bypass grafting at public hospitals in Finland between 1998 and 2002. The main outcome measure was the odds of claiming and receiving compensation. RESULTS Men were less likely to claim compensation (odds ratio [OR] 0.66; 95% confidence interval 0.54-0.81), but among those having claimed were more likely to receive compensation (OR 2.08; 1.15-3.75) than women. Patients with a co-morbidity were more likely to claim (OR 1.29; 1.06-1.57), but among those having claimed were less likely to receive compensation (OR 0.52; 0.31-0.86) than those without a co-morbidity. Advanced age reduced the probability of claiming (OR 0.71; 0.52-0.96). CONCLUSIONS Although high-risk patients file a claim more frequently than low-risk patients, the latter have a higher probability of getting their claims accepted and receiving compensation. This risk pattern is probably a reflection of compensation practices related to patient injuries involving an infection.
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Affiliation(s)
- Jutta Järvelin
- Centre for Health Economics - CHESS, National Institute for Health and Welfare, Helsinki, Findland.
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30
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Hwang K, Johnston M, Tulsky D, Wood K, Dyson-Hudson T, Komaroff E. Access and Coordination of Health Care Service for People With Disabilities. JOURNAL OF DISABILITY POLICY STUDIES 2008. [DOI: 10.1177/1044207308315564] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Individuals with disabilities often have multiple complex medical and nonmedical needs. Furthermore, in the current facility-directed health care system, they are at enhanced risk of receiving poorly coordinated, suboptimal care. This is especially problematic because individuals with disabilities face multiple barriers to receiving quality health care services, ranging from structural barriers (e.g., physical access to doctors' offices) to procedural barriers (e.g., difficulty scheduling appointments, problems obtaining insurance coverage). By contrast, a consumer-directed approach to health care (distinct from facility-directed health care) can be effectual, cost-effective, and subjectively satisfying. This brief commentary addresses the importance of a consumer-directed approach to the delivery of health care to individuals with disabilities and the need for specific assessments of the experiences of people with disabilities regarding their care. As such, it proposes recommendations for future policy interventions.
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Affiliation(s)
- Karen Hwang
- University of Medicine and Dentistry of New Jersey-New Jersey Medical and School Kessler Medical Rehabilitation Research and Education Center, West Orange, New Jersey,
| | | | - David Tulsky
- Kessler Medical Rehabilitation Research and Education Center, West Orange, New Jersey and University of Medicine and Dentistry of New Jersey-New Jersey Medical School
| | - Ken Wood
- Kessler Medical Rehabilitation Research and Education Center, West Orange, New Jersey and University of Medicine and Dentistry of New Jersey-New Jersey Medical School
| | - Trevor Dyson-Hudson
- Kessler Medical Rehabilitation Research and Education Center, West Orange, New Jersey and University of Medicine and Dentistry of New Jersey-New Jersey Medical School
| | - Eugene Komaroff
- Kessler Medical Rehabilitation Research and Education Center, West Orange, New Jersey and University of Medicine and Dentistry of New Jersey-New Jersey Medical School
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Xiao H, Barber JP. The effect of perceived health status on patient satisfaction. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:719-725. [PMID: 18179667 DOI: 10.1111/j.1524-4733.2007.00294.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To examine the effect of perceived health status on three components of patient satisfaction. METHODS The Household Component of the 1999 Medical Expenditure Panel Survey for people 35-64 years of age was used to examine the effect of perceived health status on patient satisfaction measured in terms of access to care, provider quality and quality of care. Descriptive statistics and multivariate regression were used to describe the subjects and to examine the relationship between patient satisfaction and perceived health status controlling for patient demographic factors, health factors and provider characteristics. All analyses used STATA 8.0 which is designed to analyze weighted data. RESULTS A total of 4,417 patients (71% women) met the inclusion criteria for the study. Patients who rated their health excellent or good scored higher on the three dimensions of patient satisfaction. Higher scores on one or more components of patient satisfaction were associated with being older, married, better educated and having higher income, health insurance and good mental health. Seeing the health-care provider for an old problem resulted in lower levels of patient satisfaction. Provider characteristics significantly related to patient satisfaction were listening to the patient, being a specialist, seeing patients in an office setting and being located in the South. CONCLUSIONS This study has shown that patient satisfaction is influenced by a person's self-perceived health status and other personal characteristics that are external to the delivery of health care. These findings suggest that patient satisfaction data should be used judiciously because a significant portion of the variation may be attributed to factors endogenous to the patient and therefore are not amenable to provider intervention.
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Affiliation(s)
- Hong Xiao
- College of Pharmacy and Pharmaceutical Science, Florida A&M University, Tallahassee, FL 32307, USA.
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32
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Chan L, Ciol MA, Shumway-Cook A, Yorkston KM, Dudgeon BJ, Asch SM, Hoffman JM. A longitudinal evaluation of persons with disabilities: does a longitudinal definition help define who receives necessary care? Arch Phys Med Rehabil 2008; 89:1023-30. [PMID: 18503795 DOI: 10.1016/j.apmr.2007.10.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 10/19/2007] [Accepted: 10/30/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess, using a longitudinal definition, the impact of disability on a broad range of objective health care quality indicators. DESIGN Longitudinal cohort study following up with patients over several years. The first 2 interviews, 1 year apart, were used to determine each patient's disability status in activities of daily living (ADLs). Assessment of the health care indicators commenced after the second interview and continued throughout the survey period (an additional 1-3y). SETTING National survey. PARTICIPANTS Participants (N=29,074) of the Medicare Current Beneficiary Survey (1992-2001) with no, increasing, decreasing, and stable ADL disability. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The incidence of 5 avoidable outcomes, receipt of 3 preventive care measures, and adherence to 32 diagnostically based indicators assessing the quality of treatment for acute myocardial infarction [AMI], angina, breast cancer, cerebrovascular accident, transient ischemic attack, cholelithiasis, chronic obstructive pulmonary disease [COPD], congestive heart failure, depression, gastrointestinal bleeding, diabetes, and hypertension. RESULTS For most indicators, less than 75% of eligible patients received necessary care, regardless of disability status. For 5 indicators, less than 50% of patients received appropriate treatment. In a logistic regression analysis that controlled for patient age, sex, race, and income, disability status was a significant factor in 7 quality measures (AMI, breast cancer, COPD, diabetes, angina, pneumonia, annual visits). CONCLUSIONS Using a longitudinal definition of disability and objective health quality indicators, we found that disability status can be an important factor in determining receipt of quality health care in a broad range of diagnostic categories. However, the impact of disability status varies depending on the indicator measured. In this cohort of patients, the changing nature of a person's disability seems to have less impact than whether they ever have had any functional deficits.
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Affiliation(s)
- Leighton Chan
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of Health, Bethesda, MD 20892-1604, USA.
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33
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Managing activity difficulties at home: a survey of Medicare beneficiaries. Arch Phys Med Rehabil 2008; 89:1256-61. [PMID: 18534553 DOI: 10.1016/j.apmr.2007.11.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 09/12/2007] [Accepted: 11/05/2007] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe assistance from helpers and use of assistive technology and environmental modification by community-dwelling people with difficulties in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). DESIGN Cross-sectional study using the 2004 Medicare Current Beneficiary Survey. SETTING Community. PARTICIPANTS Nationally representative sample of 14,500 Medicare beneficiaries (mean age, 71.5 y; 55% female; 49% currently married; 68% living with others; 84% white). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-reported difficulty with ADLs and IADLs; uses of help, assistive technology, and/or environmental modification. RESULTS Difficulties were reported most frequently for heavy housework, walking, and shopping; money management, shopping, and light housework were reported as activities most often needing a helper. Walking, bathing, and toileting were activities most often needing uses of assistive technology. Bathroom modifications were the most commonly reported environmental modification. Results from a logistic regression showed that advancing age was the primary factor associated with increasing use of helpers and assistive technology or both for difficult activities. CONCLUSIONS Uses of helpers, assistive technology, and environmental modification are common but vary by type of ADL and/or IADL and age. Focused studies regarding uses of help and access to assistive technology and environmental modification appear needed to support community living. Public education about methods and types of accommodations appears needed and may substitute for or augment guidance from care providers.
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Elliott MN, Beckett MK, Kanouse DE, Hambarsoomians K, Bernard S. Problem-Oriented Reporting of CAHPS Consumer Evaluations of Health Care. Med Care Res Rev 2007; 64:600-14. [PMID: 17717379 DOI: 10.1177/1077558707304632] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Consumer Assessment of Health Care Providers and Systems (CAHPS) is an organized effort to provide consumers with standardized, comprehensible, and usable data regarding consumers' experiences with health care. In its Medicare and other summary reports, CAHPS emphasizes the frequency of the most positive experiences. Cognitive models of survey response combined with attitude theory suggest that performance measurement might be further improved by the addition of problem-oriented reporting, which highlights the frequency of negative experiences. We propose criteria and use them to assess whether problem-oriented reporting provides valid, precise, and complementary information. Analysis of the 2000 CAHPS Medicare Fee-For-Service and 2001 CAHPS Medicare Advantage survey data shows that problem-oriented reporting (1) is viable, interpretable, and unlikely to represent noise; (2) has statistical power sufficient to capture important differences of magnitudes commonly observed; and (3) provides information that complements standard reporting.
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Hoffman JM, Shumway-Cook A, Yorkston KM, Ciol MA, Dudgeon BJ, Chan L. Association of mobility limitations with health care satisfaction and use of preventive care: a survey of Medicare beneficiaries. Arch Phys Med Rehabil 2007; 88:583-8. [PMID: 17466726 DOI: 10.1016/j.apmr.2007.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the association between satisfaction with health care, the use of preventive health care, and mobility limitation. DESIGN Cross-sectional analysis of survey data. SETTING Community. PARTICIPANTS A total of 12,769 people, age greater than 65, who participated in the 2001 Medicare Current Beneficiary Survey. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-report of mobility limitation, satisfaction, and use of preventive health care (immunizations, cancer screening). Sampling weights were used in all analyses, including logistic regression for survey data, to calculate estimates for a Medicare population of 31 million. RESULTS After controlling for sociodemographic characteristics, Medicare beneficiaries with mobility limitations were significantly more dissatisfied with their health care compared with beneficiaries without mobility limitations. Receipt of preventive care did not differ for those with and without mobility limitation on some preventive services. CONCLUSIONS Mobility limitation is highly associated with dissatisfaction with health care among older adult beneficiaries. Although Medicare beneficiaries may receive similar rates of preventive care, those with mobility limitation may have more difficulty accessing services and be more dissatisfied with their health care in general.
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Affiliation(s)
- Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195-6490, USA.
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36
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Burgio KL, Goode PS, Richter HE, Locher JL, Roth DL. Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: validation of three global patient ratings. Neurourol Urodyn 2006; 25:411-7. [PMID: 16652380 DOI: 10.1002/nau.20243] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS To test the validity of three patient global ratings, satisfaction, perception of improvement, and estimated percent improvement, for measuring outcomes of behavioral treatment for urinary incontinence. METHODS This report is a secondary analysis of data from three randomized controlled trials testing behavioral interventions for incontinence. Participants were 359 community-dwelling women, aged 40-92 years, with stress, urge, or mixed urinary incontinence. All participants received an 8-week program of clinic-based or self-administered behavioral training. Subjective outcomes included a patient satisfaction question (PSQ), global perception of improvement (GPI), and estimated percent improvement (EPI). Convergent validity was tested by examining the relationship between each measure and reduction of incontinence (bladder diary), change on the incontinence impact questionnaire (IIQ), and desire for another treatment. Discriminant validity was explored by examining the relationship of the global ratings to five measures not expected to be related to outcome (age, race, BMI, education level, and change in perceived pain). RESULTS All three patient global ratings were significantly associated with each other (P < 0.0001), with diary measures of reduction of incontinence episodes (P < 0.0001), and change in the IIQ (P < 0.005), and inversely associated with desire for another treatment (P < 0.0001). All three patient ratings were not significantly associated with age, race, BMI, education level, or change in perceived pain. CONCLUSION Patient global ratings of satisfaction, perception of improvement, and estimated percent improvement have acceptable convergent and discriminant validity for measuring outcomes in studies of behavioral treatment for urinary incontinence.
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Affiliation(s)
- Kathryn L Burgio
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama 35233, USA.
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37
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Iezzoni LI, Killeen MB, O'Day BL. Rural residents with disabilities confront substantial barriers to obtaining primary care. Health Serv Res 2006; 41:1258-75. [PMID: 16899006 PMCID: PMC1797079 DOI: 10.1111/j.1475-6773.2006.00534.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To learn about the health care experiences of rural residents with disabilities. STUDY SETTING Rural areas in Massachusetts and Virginia. STUDY DESIGN Local centers for independent living recruited 35 adults with sensory, physical, or psychiatric disabilities to participate in four focus group interviews. DATA COLLECTION METHODS Verbatim transcripts of interviews were reviewed to identify major themes. PRINCIPAL FINDINGS Interviewees described the many well-recognized impediments to health care in rural America; disability appears to exacerbate these barriers. Interviewees reported substantial difficulties finding physicians who understand their disabilities and sometimes feel that they must teach their local doctors about their underlying conditions. Interviewees described needing to travel periodically to large medical centers to get necessary specialty care. Many are poor and are either uninsured or have Medicaid coverage, complicating their searches for willing primary care physicians. Because many cannot drive, they face great difficulties getting to their local doctor and especially making long trips to urban centers. Available public transportation often is inaccessible and unreliable. Physicians' offices are sometimes located in old buildings that do not have accessible entrances or equipment. Based on their personal experiences, interviewees perceive that rural areas are generally less sensitive to disability access issues than urban areas. CONCLUSIONS Meeting the health care needs of rural residents with disabilities will require interventions beyond health care, involving transportation and access issues more broadly.
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Affiliation(s)
- Lisa I Iezzoni
- Harvard Medical School, 330 Brookline Avenue RO-137, Boston, MA 02215, USA
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38
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Abstract
OBJECTIVE To determine whether difficulty walking and the strategies persons use to compensate for this deficit influenced downstream Medicare expenditures. DATA SOURCE Secondary data analysis of Medicare claims data (1999-2000) for age-eligible Medicare beneficiaries (N=4,997) responding to the community portion of the 1999 National Long Term Care Survey (NLTCS). STUDY DESIGN Longitudinal cohort study. Walking difficulty and compensatory strategy were measured at the 1999 NLTCS, and used to predict health care use as measured in Medicare claims data from the survey date through year-end 2000. DATA EXTRACTION Respondents to the 1999 community NLTCS with complete information on key explanatory variables (walking difficulty and compensatory strategy) were linked with Medicare claims to define outcome variables (health care use and cost). PRINCIPAL FINDINGS Persons who reported it was very difficult to walk had more downstream home health visits (1.1/month, p<.001), but fewer outpatient physician visits (-0.16/month, p<.001) after controlling for overall disease burden. Those using a compensatory strategy for walking also had increased home health visits/month (0.55 for equipment, 1.0 for personal assistance, p<.001 for both) but did not have significantly reduced outpatient visits. Persons reporting difficulty walking had increased downstream Medicare costs ranging from 163 US dollars to 222 US dollars/month (p<.001) depending upon how difficult walking was. Less than half of the persons who used equipment to adapt to walking difficulty had their difficulty fully compensated by the use of equipment. Persons using equipment that fully compensated their difficulty used around 300 US dollars/month less in Medicare-financed costs compared with those with residual difficulty. CONCLUSIONS Difficulty walking and use of compensatory strategies are correlated with the use of Medicare-financed services. The potential impact on the Medicare program is large, given how common such limitations are among the elderly.
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Affiliation(s)
- Donald H Taylor
- Duke University Center for Health Policy, Terry Sanford Institute of Public Policy, 302 Towerview Road, Box 90253, Durham, NC 27708, USA
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39
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Kroll T, Jones GC, Kehn M, Neri MT. Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry. HEALTH & SOCIAL CARE IN THE COMMUNITY 2006; 14:284-93. [PMID: 16787479 DOI: 10.1111/j.1365-2524.2006.00613.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Individuals with physical disabilities are less likely to utilise primary preventive healthcare services than the general population. At the same time they are at greater risk for secondary conditions and as likely as the general population to engage in health risk behaviours. This qualitative exploratory study had two principal objectives: (1) to investigate access barriers to obtaining preventive healthcare services for adults with physical disabilities and (2) to identify strategies to increase access to these services. We conducted five focus group interviews with adults (median age: 46) with various physically disabling conditions. Most participants were male Caucasians residing in Virginia, USA. Study participants reported a variety of barriers that prevented them from receiving the primary preventive services commonly recommended by the US Preventive Services Task Force. We used a health services framework to distinguish structural-environmental (to include inaccessible facilities and examination equipment) or process barriers (to include a lack of disability-related provider knowledge, respect, and skilled assistance during office visits). Participants suggested a range of strategies to address these barriers including disability-specific continuing education for providers, the development of accessible prevention-focused information portals for people with physical disabilities, and consumer self-education, and assertiveness in requesting recommended services. Study findings point to the need for a more responsive healthcare system to effectively meet the primary prevention needs of people with physical disabilities. The authors propose the development of a consumer- and provider-focused resource and information kit that reflects the strategies that were suggested by study participants.
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Affiliation(s)
- Thilo Kroll
- National Rehabilitation Hospital, Center for Health & Disability Research, Research Division, Washington, DC 20010-2949, USA
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40
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Kilmer DD, Zhao HH. Obesity, Physical Activity, and the Metabolic Syndrome in Adult Neuromuscular Disease. Phys Med Rehabil Clin N Am 2005; 16:1053-62, xi. [PMID: 16214059 DOI: 10.1016/j.pmr.2005.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- David D Kilmer
- Department of Physical Medicine and Rehabilitation, University of California-Davis Medical Center, 4860 Y Street, Suite 3850, Sacramento, CA 95817, USA.
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41
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Ramirez A, Farmer GC, Grant D, Papachristou T. Disability and preventive cancer screening: results from the 2001 California Health Interview Survey. Am J Public Health 2005; 95:2057-64. [PMID: 16195509 PMCID: PMC1449483 DOI: 10.2105/ajph.2005.066118] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We sought to evaluate preventive cancer screening compliance among adults with disability in California. METHODS We used data from the 2001 California Health Interview Survey to compare disabled and nondisabled adults for differences in preventive cancer screening behaviors. Compliance rates for cancer screening tests (mammography, Papanicolaou test, prostate-specific antigen, sigmoidoscopy/colonoscopy, and fecal occult blood test) between the 2 subpopulations were evaluated. RESULTS Women with disabilities were 17% (Papanicolaou tests) and 13% (mammograms) more likely than women without disabilities to report noncompliance with cancer screening guidelines. Interactions between disability and reports of a doctor recommendation on cervical cancer screening were significant; women with disabilities had a lower likelihood of receiving a recommendation. Men with disabilities were 19% less likely than men without disabilities to report a prostate-specific antigen test within the last 3 years. CONCLUSIONS secondary to structural and/or clinical factors underpinning the differences found.
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Affiliation(s)
- Anthony Ramirez
- University of California Los Angeles Center for Health Policy Research and the California Health Interview Survey, Los Angeles 90024, USA.
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42
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Hoffman JM, Yorkston KM, Shumway-Cook A, Ciol MA, Dudgeon BJ, Chan L. Effect of communication disability on satisfaction with health care: a survey of medicare beneficiaries. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2005; 14:221-8. [PMID: 16229673 DOI: 10.1044/1058-0360(2005/022)] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 07/18/2005] [Indexed: 05/04/2023]
Abstract
PURPOSE To examine the prevalence and characteristics of community-dwelling Medicare beneficiaries reporting a communication disability and the relationship between that disability and dissatisfaction with medical care. METHOD A total of 12,769 Medicare Current Beneficiary Survey respondents age 65 and older in 2001 were categorized by level of communication disability. Sampling weights were used to make inferences about the entire Medicare population. RESULTS Over 16 million beneficiaries reported a communication disability. Hearing problems were most commonly reported (41.99%). The association between dissatisfaction and communication disability was statistically significant (p <or= .05) for 8 of 10 items. CONCLUSIONS Prevalence of dissatisfaction among those with a communication disability varied, ranging from 3.43% to 19.34%. Respondents with a communication disability reported much more dissatisfaction when compared with those respondents without a communication disability.
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Affiliation(s)
- Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle 98195-6490, USA.
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43
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Collins EG, Langbein WE, Smith B, Hendricks R, Hammond M, Weaver F. Patients' perspective on the comprehensive preventive health evaluation in veterans with spinal cord injury. Spinal Cord 2005; 43:366-74. [PMID: 15685261 DOI: 10.1038/sj.sc.3101708] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Survey research methods. OBJECTIVES To assess patient satisfaction with the annual comprehensive preventative health evaluation (CPHE) and to determine if the patient's needs were being met. SETTING Department of Veterans Affairs National Survey, United States. METHODS A total of 853 subjects with spinal cord injuries participated in a mailed survey regarding the annual CPHE. Subjects were asked about satisfaction with the examination, preferences on how the examination is conducted and whether their needs were being met with the examination. RESULTS In all, 76% of the subjects that responded to the survey had completed a CPHE within the previous year. Subjects cited getting their medication and supplies refilled and talking to the doctor as the top two reasons for completing the evaluation. Subjects indicated that they would most like to discuss their muscle strength and weakness, bladder care, chronic pain, digestion and bowel care issues, and equipment problems during their evaluation. The majority of subjects (81%) indicated that they were satisfied with the CPHE. Subjects that were satisfied with the CPHE were also more satisfied with other aspects of care as well. CONCLUSION The majority of respondents had completed a CPHE within the previous year. Most respondents cite health issues related to the spinal cord injury as areas they would most like to discuss during the evaluation. The majority of subjects were satisfied with the conduct of the CPHE.
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Affiliation(s)
- E G Collins
- Midwest Center for Health Services and Policy Research, Research & Development, Edward Hines Jr, Veterans Affairs Hospital, Hines, IL 60141, USA
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Iezzoni LI, Davis RB, Soukup J, O'Day B. Physical and sensory functioning over time and satisfaction with care: the implications of getting better or getting worse. Health Serv Res 2004; 39:1635-51. [PMID: 15533179 PMCID: PMC1361090 DOI: 10.1111/j.1475-6773.2004.00310.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine whether those persons whose sensory or physical functioning improved or worsened over one year are more or less satisfied with their health care. DATA SOURCES 1996 and 1997 Medicare Current Beneficiary Survey (MCBS). STUDY DESIGN The MCBS surveys a nationally representative, longitudinal panel of Medicare beneficiaries about their sociodemographic attributes; vision, hearing, and various mobility functions; and 10 items representing satisfaction with and access to health care. Using multivariable logistic regression and controlling for sociodemographic factors, we computed adjusted odds ratios of dissatisfaction with care, examining the effects of changes in sensory or physical functioning. Analyses accounted for MCBS sampling weights. DATA EXTRACTION METHODS We identified 9,974 community-dwelling respondents, 18 years old and over who answered the 1996 and 1997 MCBS. We assessed five categories of sensory or physical functioning (vision; hearing; walking; reaching overhead; and grasping and writing) and compared 1996 and 1997 responses to identify those whose functioning improved or worsened. PRINCIPAL FINDINGS Worsened functioning was strongly associated with older age, low income, and low educational attainment. Improved functioning was rarely significantly associated with satisfaction; an exception involved substantially lower rates of dissatisfaction with "ease and convenience" of getting to physicians. Worsened functioning was often statistically significantly associated with dissatisfaction, always with adjusted odds ratios >1.0. Across all five functional categories, persons whose functioning worsened displayed significantly greater dissatisfaction with overall quality, ease, and costs or care. CONCLUSIONS Persons whose functioning improved rarely reported better satisfaction than did those whose functioning did not improve, while those whose functioning worsened expressed more systematic reservations about their care.
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Affiliation(s)
- Lisa I Iezzoni
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Pezzin LE, Dillingham TR, Mackenzie EJ, Ephraim P, Rossbach P. Use and satisfaction with prosthetic limb devices and related services. Arch Phys Med Rehabil 2004; 85:723-9. [PMID: 15129395 DOI: 10.1016/j.apmr.2003.06.002] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To examine the use and satisfaction with prosthetic limb devices and satisfaction with prosthetist services in a large and diverse sample of persons with limb loss. DESIGN Retrospective cohort study. SETTING General community. PARTICIPANTS Persons aged 18 to 84 years identified from the Amputee Coalition of America registry as having a major upper- or lower-limb loss due to vascular disease, trauma, or malignancy. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Use and satisfaction with prosthetic limb devices and satisfaction with prosthetists' services, assessed via structured telephone interviews. RESULTS Most persons (94.5%) surveyed had a prosthesis and used it extensively (71h/wk). Most persons with amputations appeared to be satisfied with the overall performance of their prostheses (75.7%). Nearly one third of them, however, expressed dissatisfaction with their prostheses' comfort. Frequency of prosthesis use and satisfaction with the device were significantly higher among those with shorter timing to first prosthesis fitting, even after controlling for a wide array of respondents' sociodemographic and amputation characteristics. Overall, persons with amputations in our sample had positive assessments of their prosthetists' quality. Less favorable ratings concerned items related to the prosthetists' interpersonal skills. Multivariate analyses showed that men and black persons with amputations were less likely than their female or white counterparts to have favorable perceptions about their prosthetists across all dimensions of provider quality. Persons with fewer years of schooling were also less likely to be satisfied with their prosthetist's interpersonal manner. There were no significant differences in prosthesis use, satisfaction, or assessment of prosthetists' quality based on amputation etiology or amputation level. CONCLUSIONS Efforts should be directed at minimizing the interval from surgery to first prosthesis fitting and at improving communication between patients and prosthetists, to improve the quality of care provided to the growing numbers of persons with limb loss.
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Affiliation(s)
- Liliana E Pezzin
- Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Tooth LR, Ottenbacher KJ, Smith PM, Illig SB, Linn RT, Granger CV. Satisfaction with medical rehabilitation after spinal cord injury. Spine (Phila Pa 1976) 2004; 29:211-9; discussion 219. [PMID: 14722417 DOI: 10.1097/01.brs.0000107236.74004.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE To predict satisfaction with medical rehabilitation. SUMMARY OF BACKGROUND DATA While spinal cord injury (SCI) patient satisfaction with life and community services has been investigated, satisfaction with medical rehabilitation has not. METHODS Information submitted to the Uniform Data System for Medical Rehabilitation (1998-2001) by 134 hospitals/rehabilitation facilities in the United States (n = 6,205 patients with SCI) was examined. Predictors were sociodemographic variables, Case Mix Groupings (CMG) (401-505, 5001), length of stay, rehospitalization, follow-up therapy, and health maintenance. Satisfaction was assessed at a mean of 92.2 days (SD 11.9 days) postdischarge. Data were analyzed according to who reported the outcome (patient, n = 3,858 or family/other, n = 1,869). Statistical modeling was conducted using logistic regression. RESULTS High overall satisfaction was reported (94%). Significant predictors for the patient report data were CMG and rehospitalization. Compared with CMG 5001 (short stay, <3 days), patients in CMGs 401/2/3 and 501/2/3/4/5 had a 54% to 74% lower likelihood of being dissatisfied. Rehospitalized patients had a higher likelihood of dissatisfaction (odds ratio 2.3, 95% confidence interval 1.7 to 3.2). Significant predictors for the family/other report data were CMG (compared to CMG 5001, CMGs 401/2, 403, and 501/2 had a 70% lower likelihood of dissatisfaction), rehospitalization (odds ratio 1.7, 95% confidence interval 1.1-2.5), and marital status (married = 50% lower likelihood of dissatisfaction, 95% confidence interval 0.26-0.96). CONCLUSIONS Satisfaction with medical rehabilitation services following SCI is related to functional abilities, rehospitalization, and marital status. Slightly different results were found for whether satisfaction was rated by the patient or family/other. The complex relationships among satisfaction, patient demographics, and functional status require continued examination.
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Affiliation(s)
- Leigh R Tooth
- School of Population Health, University of Queensland, Brisbane, Australia
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Abstract
Many Americans are concerned about their access to health care in the future, especially their ability to pay for needed services. However, a person with a disabling condition requiring ongoing clinical vigilance, supportive care, and other assistive services or technologies faces special difficulties: that person is the "canary in the mine," warning others about fundamental problems within our health care system. Persons with disabilities who have health insurance are often unable to get items and services not covered by their plans. They experience more problems than others with follow-up care, availability of specialists, getting to doctors, and obtaining help during off hours. These problems suggest that people with disabilities fall into the "quality chasm," the metaphor used by the Institute of Medicine to describe the gap between ideal care and current reality. The Crossing the Quality Chasm report suggests 6 aims for fundamental reform, exhorting the health care system to become safe, effective, patient-centered, timely, efficient, and equitable. Each of these aims holds special resonance for persons with disabilities. Despite the compelling need to overhaul the health care system, the American public as yet seems little inclined to fundamental change. Perhaps the impetus must come from subgroups within the population who are particularly at risk from the current system, such as persons with disabilities. As solutions are crafted, people with disabilities, their families, and communities should help design and direct fundamental changes to the health care system.
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Affiliation(s)
- Lisa I Iezzoni
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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