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Yazdanbakhsh E, Bohlouli B, Patterson S, Amin M. The use of general anesthesia for dental treatment of children with special healthcare needs in Alberta, Canada. Int J Paediatr Dent 2024. [PMID: 38988130 DOI: 10.1111/ipd.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/23/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Children with special healthcare needs (SHCN) often require specialized interventions due to their disabilities. Dental general anesthesia (DGA) is a treatment modality, which improves their access to care but concerns about repeated DGAs persist. AIM This study investigated DGA utilization in children with SHCN and identified factors associated with multiple DGAs in Alberta, Canada (2010-2020). DESIGN This retrospective population-based study used administrative data encompassing all children (<18 years) undergoing DGA in publicly funded facilities. Children were identified as SHCN based on their diagnosis codes and categorized into behavioral/psychiatric disorders, mental/intellectual disabilities, physical disabilities, systemic conditions, syndromes/congenital anomalies, physical-mental disabilities, and disabilities with medical conditions. RESULTS This study analyzed 3884 DGA visits for children with SHCN, predominantly males aged 6-11 and from low-income families. Mental/intellectual disabilities were prevalent (31.8%), and autism was the leading disease. Caries was the primary dental diagnosis across all groups, whereas pulp problems were higher in psychiatric/behavioral disorders (23.6%), and periodontal problems were more common in physical-mental disabilities (13.2%). 28.7% had multiple DGAs, with younger age, disabilities with medical conditions, mental/intellectual disabilities, and initial pulp treatments, increasing the likelihood of multiple DGAs. CONCLUSION This study highlights the importance of individualized prevention and less conservative treatments for younger children to reduce oral health disparities.
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Affiliation(s)
- Elnaz Yazdanbakhsh
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Babak Bohlouli
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Steven Patterson
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Amin
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Ellison J, Pudasainy S, Bellerose M, Quinn D, Borrero S, Olson I, Chen Q, Shireman TI, Jarlenski MP. Contraceptive Use Among Traditional Medicare And Medicare Advantage Enrollees. Health Aff (Millwood) 2024; 43:98-107. [PMID: 38190592 DOI: 10.1377/hlthaff.2023.00286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Medicare is the primary source of health insurance coverage for reproductive-age people with Social Security Disability Insurance. However, Medicare does not require contraceptive coverage for pregnancy prevention, and little is known about contraceptive use in traditional Medicare and Medicare Advantage. We analyzed Medicare and Optum data to assess variations in contraceptive use and methods used by traditional Medicare and Medicare Advantage enrollees, as well as among enrollees with and without noncontraceptive clinical indications. Clinically indicated contraceptives are used for reasons other than pregnancy prevention, including menstrual regulation or to treat acne, menorrhagia, and endometriosis. Contraceptive use was higher among Medicare Advantage enrollees than traditional Medicare enrollees, but use in both populations was low compared with contraceptive use among Medicaid enrollees. We found significant variation by Medicare type with respect to contraceptive methods used. Relative to traditional Medicare, the probability of long-acting reversible contraception was more than three times higher in Medicare Advantage, and the probability of tubal sterilization was more than ten times higher. Overall, Medicare enrollees with noncontraceptive clinical indications had twice the probability of contraceptive use as those without them. Medicare coverage of all contraceptive methods without cost sharing would help address financial barriers to contraceptives and support the reproductive autonomy of disabled enrollees.
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Scime NV, Brown HK, Metcalfe A, Simpson AN, Brennand EA. Bilateral salpingo-oophorectomy at the time of benign hysterectomy among females with disabilities: a population-based cross-sectional study. Am J Obstet Gynecol 2023; 229:658.e1-658.e17. [PMID: 37544349 DOI: 10.1016/j.ajog.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Up to 40% of patients aged ≤55 years undergo concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy, with practice variation in bilateral salpingo-oophorectomy occurring along the lines of patient health and social factors. Disability is common in premenopausal women and is an important determinant of reproductive health more broadly; however, studies on bilateral salpingo-oophorectomy rates among women with disabilities are lacking. OBJECTIVE This study aimed to examine whether the use of concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy differs by preexisting disability status in adult females aged ≤55 years. STUDY DESIGN This population-based cross-sectional study used data from the 2016-2019 US National Inpatient Sample. Females undergoing inpatient hysterectomy for a benign gynecologic indication (n=74,315) were classified as having physical (6.1%), sensory (0.1%), intellectual or developmental (0.2%), or multiple (0.2%) disabilities and compared with those without a disability. Logistic regression was used to estimate risk ratios for differences in bilateral salpingo-oophorectomy rates by disability status, adjusted for patient and clinical factors. Models were stratified by potentially avoidable or potentially appropriate bilateral salpingo-oophorectomy based on the presence of clinical indications for ovarian removal and by age group. RESULTS Bilateral salpingo-oophorectomy at the time of benign hysterectomy occurred in 26.0% of females without a disability, with rates clearly elevated in those with a physical (33.2%; adjusted risk ratio, 1.10; 95% confidence interval, 1.05-1.14) or intellectual or developmental (31.1%; adjusted risk ratio, 1.32; 95% confidence interval, 1.02-1.64) disability, possibly elevated in those with multiple disabilities (38.2%; adjusted risk ratio, 1.20; 95% confidence interval, 0.94-1.45), and similar in those with a sensory disability (31.2%; adjusted risk ratio, 0.98; 95% confidence interval, 0.83-1.13). The results were similar but with lower statistical precision for potentially avoidable and potentially appropriate bilateral salpingo-oophorectomy, which occurred in 9.1% and 17.0% of females without a disability, respectively. The largest differences in bilateral salpingo-oophorectomy rates among women with any disability were observed in the perimenopausal 45- to 49-year age group. CONCLUSION Females with disabilities experienced elevated concomitant bilateral salpingo-oophorectomy rates at the time of benign hysterectomy, particularly those with an intellectual or developmental disability and those of perimenopausal age, although some estimates were imprecise. Equity-focused physician training in surgical counseling and research into the epidemiology and experiences of gynecologic conditions among females with a disability may be beneficial.
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Affiliation(s)
- Natalie V Scime
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea N Simpson
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Erin A Brennand
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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Tak HJ, Horner RD, Lee MS, Shih YCT. Impact of functional disability on health-care use and medical costs among cancer survivors. JNCI Cancer Spectr 2023; 7:pkad059. [PMID: 37584678 PMCID: PMC10505255 DOI: 10.1093/jncics/pkad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Cancer survivors with a disability are among the most vulnerable in health status and financial hardship, but no prior research has systematically examined how disability modifies health-care use and costs. This study examined the association between functional disability among cancer survivors and their health-care utilization and medical costs. METHODS We generated nationally representative estimates using the 2015-2019 Medical Expenditure Panel Survey. Outcomes included use of 6 service types (inpatient, outpatient, office-based physician, office-based nonphysician, emergency department, and prescription) and medical costs of aggregate services and by each of 6 service types. The primary independent variable was a categorical variable for the total number of functional disabilities. We employed multivariable generalized linear models and 2-part models, adjusting for sociodemographics and health conditions and accounting for survey design. RESULTS Among cancer survivors (n = 9359; weighted n = 21 046 285), 38.8% reported at least 1 disability. Compared with individuals without a disability, cancer survivors with 4 or more disabilities experienced longer hospital stays (adjusted average marginal effect = 1.14 days, 95% confidence interval [CI] = 0.55 to 1.73), more visits to an office-based physician (average marginal effect = 1.43 visits, 95% CI = 0.51 to 2.35), and a greater number of prescriptions (average marginal effect = 12.1 prescriptions, 95% CI = 9.27 to 15.0). Their total (average marginal effect = $9537, 95% CI = $5713 to $13 361) and out-of-pocket (average marginal effect = $639, 95% CI = $79 to $1199) medical costs for aggregate services were statistically significantly higher. By type, disability in independent living was most strongly associated with greater costs for aggregate services. CONCLUSIONS Cancer survivors with a disability experienced greater health-care use and higher costs. Cancer survivorship planning for health care and financial stability should consider the patients' disability profile.
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Affiliation(s)
- Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ronnie D Horner
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Min Sok Lee
- Department of Economics, University of Chicago, Chicago, IL, USA
| | - Ya-Chen Tina Shih
- Jonsson Comprehensive Cancer Center and Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Horner-Johnson W, Dissanayake M, Marshall N, Snowden JM. Perinatal Health Risks And Outcomes Among US Women With Self-Reported Disability, 2011-19. Health Aff (Millwood) 2022; 41:1477-1485. [PMID: 36130140 DOI: 10.1377/hlthaff.2022.00497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Women with disabilities experience elevated risk for adverse pregnancy outcomes. Most studies have inferred disabilities from diagnosis codes, likely undercounting disabilities. We analyzed data, including self-reported disability status, from the National Survey of Family Growth for the period 2011-19. We compared respondents with and without disabilities on these characteristics: smoking during pregnancy, delayed prenatal care, preterm birth, and low birthweight. A total of 19.5 percent of respondents who had given birth reported a disability, which is a much higher prevalence than estimates reported in US studies using diagnosis codes. Respondents with disabilities were twice as likely as those without disabilities to have smoked during pregnancy (19.0 percent versus 8.9 percent). They also had 24 percent and 29 percent higher risk for preterm birth and low birthweight, respectively. Our findings suggest that studies using diagnosis codes may represent only a small proportion of pregnancies among people with disabilities. Measurement and analysis of self-reported disability would facilitate better understanding of the full extent of disability-related disparities, per the Affordable Care Act.
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Brown HK, Chen S, Vigod SN, Guttmann A, Havercamp SM, Parish SL, Tarasoff LA, Lunsky Y. A population-based analysis of postpartum acute care use among women with disabilities. Am J Obstet Gynecol MFM 2022; 4:100607. [PMID: 35248782 PMCID: PMC9703340 DOI: 10.1016/j.ajogmf.2022.100607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Disability is common in reproductive-aged women, and as many as 1 in 8 pregnancies occur in women with a disability. Women with disabilities experience significant social and health disparities, and are at greater risk than their nondisabled counterparts for perinatal complications. Yet, few studies have examined their postpartum acute care use. OBJECTIVE To examine risks of postpartum emergency department visits and hospital admissions among women with and without physical, sensory, and intellectual/developmental disabilities. STUDY DESIGN In this population-based study in Ontario, Canada, women with a singleton obstetrical delivery from 2003 to 2019 were classified into those with physical (n=155,500), sensory (n=49,338), intellectual/developmental (n=2650), and multiple disabilities (≥2 disabilities; n=9904), and women without disabilities (n=1,701,574). Primary outcomes were emergency department visits and hospital admissions 0 to 365 days after index delivery hospital discharge. Secondary outcomes were emergency department visits and hospital admissions by primary diagnosis (medical, psychiatric) and by timing (0-7, 8-42, 43-365 days postpartum). Adjusted relative risks comparing each disability group to those without disabilities were adjusted for age; parity; income quintile; rurality; immigrant/refugee status; prepregnancy chronic medical conditions, mental illness, and substance use disorders; and prenatal care provider type. RESULTS Any postpartum emergency department visit occurred in 23.5% of women without a disability, with risks elevated in women with physical (32.9%; adjusted relative risk, 1.27; 95% confidence interval, 1.26-1.28), sensory (30.0%; adjusted relative risk, 1.16; 95% confidence interval, 1.15-1.18), intellectual/developmental (48.8%; adjusted relative risk, 1.38; 95% confidence interval, 1.33-1.44), and multiple disabilities (42.0%; adjusted relative risk, 1.44; 95% confidence interval, 1.41-1.48) compared with women without disabilities. Similarly, any postpartum hospital admission occurred in 3.0% of women without a disability, with elevated risks in women with physical (4.8%; adjusted relative risk, 1.37; 95% confidence interval, 1.34-1.40), sensory (4.0%; adjusted relative risk, 1.19; 95% confidence interval, 1.14-1.24), intellectual/developmental (9.6%; adjusted relative risk, 1.96; 95% confidence interval, 1.73-2.21), and multiple disabilities (7.3%; adjusted relative risk, 1.77; 95% confidence interval, 1.64-1.90). Results were consistent by primary diagnosis and timing in the postpartum period. CONCLUSION Women with disabilities have elevated risk of emergency department visits and hospital admissions in the postpartum period, indicating greater postpartum morbidity, which requires attention through enhanced and extended follow-up across the postpartum period.
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Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada (Drs Brown and Tarasoff); Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (Drs Brown, Vigod, and Guttmann); Women's College Research Institute, Women's College Hospital, Toronto, Canada (Drs Brown and Vigod); Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky).
| | - Simon Chen
- Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky)
| | - Simone N Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (Drs Brown, Vigod, and Guttmann); Women's College Research Institute, Women's College Hospital, Toronto, Canada (Drs Brown and Vigod); Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky); Department of Psychiatry, University of Toronto, Toronto, Canada (Drs Vigod and Lunsky)
| | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (Drs Brown, Vigod, and Guttmann); Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky); Hospital for Sick Children, Toronto, Canada (Dr Guttmann); Department of Pediatrics, University of Toronto, Toronto, Canada (Dr Guttmann)
| | - Susan M Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, OH (Dr Havercamp)
| | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, VA (Dr Parish)
| | - Lesley A Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada (Drs Brown and Tarasoff); Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Canada (Drs Tarasoff and Lunsky)
| | - Yona Lunsky
- Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky); Department of Psychiatry, University of Toronto, Toronto, Canada (Drs Vigod and Lunsky); Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Canada (Drs Tarasoff and Lunsky)
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Le Pogam MA, Seematter-Bagnoud L, Niemi T, Assouline D, Gross N, Trächsel B, Rousson V, Peytremann-Bridevaux I, Burnand B, Santos-Eggimann B. Development and validation of a knowledge-based score to predict Fried's frailty phenotype across multiple settings using one-year hospital discharge data: The electronic frailty score. EClinicalMedicine 2022; 44:101260. [PMID: 35059615 PMCID: PMC8760435 DOI: 10.1016/j.eclinm.2021.101260] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Most claims-based frailty instruments have been designed for group stratification of older populations according to the risk of adverse health outcomes and not frailty itself. We aimed to develop and validate a tool based on one-year hospital discharge data for stratification on Fried's frailty phenotype (FP). METHODS We used a three-stage development/validation approach. First, we created a clinical knowledge-driven electronic frailty score (eFS) calculated as the number of deficient organs/systems among 18 critical ones identified from the International Statistical Classification of Diseases and Related Problems, 10th Revision (ICD-10) diagnoses coded in the year before FP assessment. Second, for eFS development and internal validation, we linked individual records from the Lc65+ cohort database to inpatient discharge data from Lausanne University Hospital (CHUV) for the period 2004-2015. The development/internal validation sample included community-dwelling, non-institutionalised residents of Lausanne (Switzerland) recruited in the Lc65+ cohort in three waves (2004, 2009, and 2014), aged 65-70 years at enrolment, and hospitalised at the CHUV at least once in the year preceding the FP assessment. Using this sample, we selected the best performing model for predicting the dichotomised FP, with the eFS or ICD-10-based variables as predictors. Third, we conducted an external validation using 2016 Swiss nationwide hospital discharge data and compared the performance of the eFS model in predicting 13 adverse outcomes to three models relying on well-designed and validated claims-based scores (Claims-based Frailty Index, Hospital Frailty Risk Score, Dr Foster Global Frailty Score). FINDINGS In the development/internal validation sample (n = 469), 14·3% of participants (n = 67) were frail. Among 34 models tested, the best-subsets logistic regression model with four predictors (age and sex at FP assessment, time since last hospital discharge, eFS) performed best in predicting the dichotomised FP (area under the curve=0·71; F1 score=0·39) and one-year adverse health outcomes. On the external validation sample (n = 54,815; 153 acute care hospitals), the eFS model demonstrated a similar performance to the three other claims-based scoring models. According to the eFS model, the external validation sample showed an estimated prevalence of 56·8% (n = 31,135) of frail older inpatients at admission. INTERPRETATION The eFS model is an inexpensive, transportable and valid tool allowing reliable group stratification and individual prioritisation for comprehensive frailty assessment and may be applied to both hospitalised and community-dwelling older adults. FUNDING The study received no external funding.
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Affiliation(s)
- Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
- Corresponding author.
| | - Laurence Seematter-Bagnoud
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Tapio Niemi
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Dan Assouline
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Nathan Gross
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Bastien Trächsel
- Department of Training, Research and Innovation, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 113 Route de Berne, Lausanne 1010, Switzerland
| | - Valentin Rousson
- Department of Training, Research and Innovation, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 113 Route de Berne, Lausanne 1010, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Bernard Burnand
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Brigitte Santos-Eggimann
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
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Mitra M, Akobirshoev I, Valentine A, Brown HK, Moore Simas TA. Severe Maternal Morbidity and Maternal Mortality in Women With Intellectual and Developmental Disabilities. Am J Prev Med 2021; 61:872-881. [PMID: 34579985 PMCID: PMC8608722 DOI: 10.1016/j.amepre.2021.05.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/01/2021] [Accepted: 05/24/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Despite increased attention on severe maternal morbidity and maternal mortality, scant research exists on adverse maternal outcomes in women with disabilities. This study compares the rates of severe maternal morbidity and maternal mortality in women with and without intellectual and developmental disabilities. METHODS This study used 2004-2017 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Analyses were conducted in 2019‒2020. The risk of severe maternal morbidity with and without blood transfusion and maternal mortality during delivery among women with and without intellectual and developmental disabilities were compared using modified Poisson regression analysis. RESULTS This study identified 32,324 deliveries to women with intellectual and developmental disabilities. Per 10,000 deliveries, 566 deliveries with severe maternal morbidity occurred in women with intellectual and developmental disabilities compared with 239 in women without intellectual and developmental disabilities. Women with intellectual and developmental disabilities had greater risk of both severe maternal morbidity (risk ratio=2.36, 95% CI=2.06, 2.69) and nontransfusion severe maternal morbidity (risk ratio=2.95, 95% CI=2.42, 3.61) in unadjusted analyses, which was mitigated in adjusted analyses for sociodemographic characteristics (risk ratio=1.74, 95% CI=1.47, 2.06; risk ratio=1.85, 95% CI=1.42, 2.41) and the expanded obstetric comorbidity index (risk ratio=1.23, 95% CI=1.04, 1.44; risk ratio=1.31, 95% CI=1.02, 1.68). The unadjusted incidence of maternal mortality in women with intellectual and developmental disabilities was 284 per 100,000 deliveries, nearly 4-fold higher than in women without intellectual and developmental disabilities (69 per 100,000 deliveries; risk ratio=4.07, 95% CI=2.04, 8.12), and the risk remained almost 3-fold higher after adjustment for sociodemographic characteristics (risk ratio=2.86, 95% CI=1.30, 6.29) and the expanded obstetric comorbidity index (risk ratio=2.30, 95% CI=1.05, 5.29). CONCLUSIONS Women with intellectual and developmental disabilities are at increased risk of severe maternal morbidity and maternal mortality. These findings underscore the need for enhanced monitoring of the needs and maternal outcomes of women with intellectual and developmental disabilities in efforts to improve maternal health.
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Affiliation(s)
- Monika Mitra
- The Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts.
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Anne Valentine
- The Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts
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Scime NV, Brown HK, Metcalfe A, Brennand EA. Prevalence of Hysterectomy by Self-Reported Disability Among Canadian Women: Findings from a National Cross-Sectional Survey. WOMEN'S HEALTH REPORTS 2021; 2:557-565. [PMID: 34909762 PMCID: PMC8665278 DOI: 10.1089/whr.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/25/2022]
Abstract
Introduction: Our objective was to investigate differences in prevalence of hysterectomy by self-reported disability status among Canadian women. Materials and Methods: We analyzed cross-sectional data from the Canadian Community Health Survey 2012 on 30,170 women aged ≥20 years. Disability was defined as reports of sometimes or often (vs. never) experiencing functional limitations or reduction in daily activities at home, school, or work. Frequency of these limitations was used as a proxy for disability severity. The outcome was self-reported hysterectomy status. Modified Poisson regression was used to quantify the prevalence ratio (PR) and 95% confidence interval (CI) for hysterectomy according to any, functional, or activity-limiting disability, after adjustment for household income, employment, education, ethnicity, and marital status. Results were stratified by age at time of data collection, categorized as childbearing (20–44 years), perimenopausal (45–59 years), and postmenopausal (60 years and older). Results: Disability was significantly and consistently associated with higher prevalence of hysterectomy in women. The strength of association was inversely related to age category, and PRs for a given age category were similar across disability types and severity levels. PRs for the association between any disability and hysterectomy were 2.18 (95% CI 1.36–3.50) for childbearing-aged women, 1.48 (95% CI 1.21–1.80) for perimenopausal women, and 1.12 (95% CI 1.02–1.24) for postmenopausal women. Conclusions: Prevalence of hysterectomy is disproportionately higher among women with self-reported disabilities compared with women without disabilities, with these differences most pronounced in women of childbearing age.
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Affiliation(s)
- Natalie V. Scime
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Hilary K. Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
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DuMontier C, Fillmore NR, Yildirim C, Cheng D, La J, Orkaby AR, Charest B, Cirstea D, Yellapragada S, Gaziano JM, Do N, Brophy MT, Kim DH, Munshi NC, Driver JA. Contemporary Analysis of Electronic Frailty Measurement in Older Adults with Multiple Myeloma Treated in the National US Veterans Affairs Healthcare System. Cancers (Basel) 2021; 13:cancers13123053. [PMID: 34207459 PMCID: PMC8233717 DOI: 10.3390/cancers13123053] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Geriatric and frailty assessment are recommended for all older adults with cancer undergoing systemic therapy, but assessments remain difficult to scale. The aim of this study was to use an electronic frailty index based on data from administrative claims and electronic health records—the Veterans Affairs Frailty Index (VA-FI-10)—to estimate frailty and its impact on older United States (US) military veterans treated for multiple myeloma (MM) throughout the national VA Healthcare System. We found frailty to be prevalent and strongly associated with mortality and hospitalizations—independently of age, race, and MM stage. We also showed that changing the way in which the VA-FI-10 is measured affects its classification of frailty for individual veterans but not its association with mortality. These findings support the VA-FI-10’s use in research investigating outcomes in frail veterans treated with contemporary MM therapies. We provide further insights into the VA-FI-10’s potential use in clinical practice. Abstract Electronic frailty indices based on data from administrative claims and electronic health records can be used to estimate frailty in large populations of older adults with cancer where direct frailty measures are lacking. The objective of this study was to use the electronic Veterans Affairs Frailty Index (VA-FI-10)—developed and validated to measure frailty in the national United States (US) VA Healthcare System—to estimate the prevalence and impact of frailty in older US veterans newly treated for multiple myeloma (MM) with contemporary therapies. We designed a retrospective cohort study of 4924 transplant-ineligible veterans aged ≥ 65 years initiating MM therapy within VA from 2004 to 2017. Initial MM therapy was measured using inpatient and outpatient treatment codes from pharmacy data in the VA Corporate Data Warehouse. In total, 3477 veterans (70.6%) were classified as frail (VA-FI-10 > 0.2), with 1510 (30.7%) mildly frail (VA-FI-10 > 0.2–0.3), 1105 (22.4%) moderately frail (VA-FI-10 > 0.3–0.4), and 862 (17.5%) severely frail (VA-FI-10 > 0.4). Survival and time to hospitalization decreased with increasing VA-FI-10 severity (log-rank p-value < 0.001); the VA-FI-10 predicted mortality and hospitalizations independently of age, sociodemographic variables, and measures of disease risk. Varying data sources and assessment periods reclassified frailty severity for a substantial portion of veterans but did not substantially affect VA-FI-10’s association with mortality. Our study supports use of the VA-FI-10 in future research involving older veterans with MM and provides insights into its potential use in identifying frailty in clinical practice.
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Affiliation(s)
- Clark DuMontier
- New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA 02130, USA; (C.D.); (A.R.O.)
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
| | - Nathanael R. Fillmore
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
- VA Boston CSP Center, Boston, MA 02130, USA; (N.D.); (M.T.B.)
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA 02130, USA; (C.Y.); (J.L.); (B.C.)
- VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Cenk Yildirim
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA 02130, USA; (C.Y.); (J.L.); (B.C.)
- VA Boston Healthcare System, Boston, MA 02130, USA
| | - David Cheng
- Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Jennifer La
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA 02130, USA; (C.Y.); (J.L.); (B.C.)
- VA Boston Healthcare System, Boston, MA 02130, USA
| | - Ariela R. Orkaby
- New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA 02130, USA; (C.D.); (A.R.O.)
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA 02130, USA; (C.Y.); (J.L.); (B.C.)
- VA Boston Healthcare System, Boston, MA 02130, USA
| | - Diana Cirstea
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Sarvari Yellapragada
- Michael E. Debakey VA Medical Center and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA;
| | - John Michael Gaziano
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA 02130, USA; (C.Y.); (J.L.); (B.C.)
- VA Boston Healthcare System, Boston, MA 02130, USA
| | - Nhan Do
- VA Boston CSP Center, Boston, MA 02130, USA; (N.D.); (M.T.B.)
- Boston University School of Medicine, Boston, MA 02118, USA
| | - Mary T. Brophy
- VA Boston CSP Center, Boston, MA 02130, USA; (N.D.); (M.T.B.)
- Boston University School of Medicine, Boston, MA 02118, USA
| | - Dae H. Kim
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA 02131, USA;
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Nikhil C. Munshi
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
- VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Jane A. Driver
- New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA 02130, USA; (C.D.); (A.R.O.)
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA; (N.R.F.); (N.C.M.)
- Correspondence: ; Tel.: +1-857-364-2560
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Cook A, Quinn ED, Rowland C. Exploring Expressive Communication Skills in a Cross-Sectional Sample of Individuals With a Dual Diagnosis of Autism Spectrum Disorder and Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:97-113. [PMID: 33651892 PMCID: PMC8552670 DOI: 10.1352/1944-7558-126.2.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 03/30/2020] [Indexed: 06/12/2023]
Abstract
Individuals with a comorbid diagnosis of Down syndrome (DS) and autism spectrum disorder (ASD) have been found to exhibit greater deficits in expressive communication than individuals with DS only. We hypothesized that individuals with a comorbid diagnosis (n = 430) would have significantly lower Communication Matrix scores and specifically social communication scores than individuals with DS alone (n = 4,352). In a sample of 4,782 individuals with DS, scores for individuals with a comorbid diagnosis were on average 18.01 points and 7.26 points lower for total score and social score respectively as compared to individuals with DS. Comorbid diagnosis accounted for 10.5% of the variance in communication scores. Between-group differences in referential gestures and symbolic communication behaviors were also observed.
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Affiliation(s)
- Alexandria Cook
- Alexandria Cook, Emily D. Quinn, and Charity Rowland, Oregon Health and Science University, Institute on Development and Disability, Portland
| | - Emily D Quinn
- Alexandria Cook, Emily D. Quinn, and Charity Rowland, Oregon Health and Science University, Institute on Development and Disability, Portland
| | - Charity Rowland
- Alexandria Cook, Emily D. Quinn, and Charity Rowland, Oregon Health and Science University, Institute on Development and Disability, Portland
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12
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Brown HK, Ray JG, Chen S, Guttmann A, Havercamp SM, Parish S, Vigod SN, Tarasoff LA, Lunsky Y. Association of Preexisting Disability With Severe Maternal Morbidity or Mortality in Ontario, Canada. JAMA Netw Open 2021; 4:e2034993. [PMID: 33555330 PMCID: PMC7871190 DOI: 10.1001/jamanetworkopen.2020.34993] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/06/2020] [Indexed: 11/14/2022] Open
Abstract
Importance Severe maternal morbidity and mortality are important indicators of maternal health. Pregnancy rates are increasing in women with disabilities, but their risk of severe maternal morbidity and mortality is unknown, despite their significant social and health disparities. Objective To determine the risk of severe maternal morbidity or mortality among women with a physical, sensory, or intellectual/developmental disability compared with women without disabilities. Design, Setting, and Participants This population-based cohort study used linked health administrative data in Ontario, Canada, from 2003 to 2018. The cohort included all singleton births to women with preexisting physical, sensory, and intellectual/developmental disabilities as well as with 2 disabilities or more compared with women without a disability. Data analysis was conducted from September 2019 to September 2020. Exposures Disabilities were identified with published algorithms applied to diagnoses in 2 physician visits or more or at least 1 emergency department visit or hospitalization. Main Outcomes and Measures Severe maternal morbidity (a validated composite of 40 diagnostic and procedural indicators) or all-cause maternal mortality, arising between conception and 42 days post partum. Relative risks were adjusted for maternal age, parity, income quintile, rurality, chronic medical conditions, mental illness, and substance use disorders. Results The cohort comprised women with physical disabilities (144 972 women; mean [SD] age, 29.8 [5.6] years), sensory disabilities (45 259 women; mean [SD] age, 29.1 [6.0] years), intellectual/developmental disabilities (2227 women; mean [SD] age, 26.1 [6.4] years), and 2 or more disabilities (8883 women; mean [SD] age, 29.1 [6.1] years), and those without disabilities (1 601 363 women; mean [SD] age, 29.6 [5.4] years). The rate of severe maternal morbidity or death was 1.7% (27 242 women) in women without a disability. Compared with these women, the risk of severe maternal morbidity or death was higher in women with a physical disability (adjusted relative risk [aRR], 1.29; 95% CI, 1.25-1.34), a sensory disability (aRR, 1.14; 95% CI, 1.06-1.21), an intellectual/developmental disability (aRR, 1.57; 95% CI, 1.23-2.01), and 2 or more disabilities (aRR, 1.74; 95% CI, 1.55-1.95). Similar aRRs were observed for severe maternal morbidity or death arising in pregnancy, from birth to 42 days post partum, and from 43 to 365 days post partum. Women with disabilities were more likely than those without disabilities to experience multiple severe maternal morbidity indicators. The most prevalent indicators in all groups were intensive care unit admission, severe postpartum hemorrhage, puerperal sepsis, and severe preeclampsia. Conclusions and Relevance In this study, women with a preexisting disability were more likely to experience severe maternal morbidity or mortality. Preconception and perinatal care provisions should be considered among women with a disability to mitigate the risk of these rare but serious outcomes.
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Affiliation(s)
- Hilary K. Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Joel G. Ray
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Susan M. Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus
| | - Susan Parish
- College of Health Professions, Virginia Commonwealth University, Richmond
| | - Simone N. Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lesley A. Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Yona Lunsky
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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13
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Agaronnik ND, Lindvall C, El-Jawahri A, He W, Iezzoni LI. Challenges of Developing a Natural Language Processing Method With Electronic Health Records to Identify Persons With Chronic Mobility Disability. Arch Phys Med Rehabil 2020; 101:1739-1746. [PMID: 32446905 PMCID: PMC7529728 DOI: 10.1016/j.apmr.2020.04.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the utility of applying natural language processing (NLP) to electronic health records (EHRs) to identify individuals with chronic mobility disability. DESIGN We used EHRs from the Research Patient Data Repository, which contains EHRs from a large Massachusetts health care delivery system. This analysis was part of a larger study assessing the effects of disability on diagnosis of colorectal cancer. We applied NLP text extraction software to longitudinal EHRs of colorectal cancer patients to identify persons who use a wheelchair (our indicator of mobility disability for this analysis). We manually reviewed the clinical notes identified by NLP using directed content analysis to identify true cases using wheelchairs, duration or chronicity of use, and documentation quality. SETTING EHRs from large health care delivery system PARTICIPANTS: Patients (N=14,877) 21-75 years old who were newly diagnosed with colorectal cancer between 2005 and 2017. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Confirmation of patients' chronic wheelchair use in NLP-flagged notes; quality of disability documentation. RESULTS We identified 14,877 patients with colorectal cancer with 303,182 associated clinical notes. NLP screening identified 1482 (0.5%) notes that contained 1+ wheelchair-associated keyword. These notes were associated with 420 patients (2.8% of colorectal cancer population). Of the 1482 notes, 286 (19.3%, representing 105 patients, 0.7% of the total) contained documentation of reason for wheelchair use and duration. Directed content analysis identified 3 themes concerning disability documentation: (1) wheelchair keywords used in specific EHR contexts; (2) reason for wheelchair not clearly stated; and (3) duration of wheelchair use not consistently documented. CONCLUSIONS NLP offers an option to screen for patients with chronic mobility disability in much less time than required by manual chart review. Nonetheless, manual chart review must confirm that flagged patients have chronic mobility disability (are not false positives). Notes, however, often have inadequate disability documentation.
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Affiliation(s)
- Nicole D Agaronnik
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA
| | - Areej El-Jawahri
- Department of Medicine, Harvard Medical School, Boston, MA; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| | - Wei He
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Lisa I Iezzoni
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA.
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14
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Eisenberg Y, Powell LM, Zenk SN, Tarlov E. Development of a Predictive Algorithm to Identify Adults With Mobility Limitations Using VA Health Care Administrative Data. Med Care Res Rev 2020; 78:572-584. [PMID: 32842872 DOI: 10.1177/1077558720950880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An estimated 31.5 million Americans have a mobility limitation. Health care administrative data could be a valuable resource for research on this population but methods for cohort identification are lacking. We developed and tested an algorithm to reliably identify adults with mobility limitation in U.S. Department of Veterans Affairs health care data. We linked diagnosis, encounter, durable medical equipment, and demographic data for 964 veterans to their self-reported mobility limitation from the Medicare Current Beneficiary Survey. We evaluated performance of logistic regression models in classifying mobility limitation. The binary approach (yes/no limitation) had good sensitivity (70%) and specificity (79%), whereas the multilevel approach did not perform well. The algorithms for predicting a binary mobility limitation outcome performed well at discriminating between veterans who did and did not have mobility limitation. Future work should focus on multilevel approaches to predicting mobility limitation and samples with greater proportions of women and younger adults.
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Affiliation(s)
- Yochai Eisenberg
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - Lisa M Powell
- Department of Health Policy and Administration, University of Illinois at Chicago, Chicago, IL, USA
| | - Shannon N Zenk
- Department of Health System Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth Tarlov
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.,Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital Hines VA Hospital, Hines IL
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15
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Identifying reproductive-aged women with physical and sensory disabilities in administrative health data: A systematic review. Disabil Health J 2020; 13:100909. [PMID: 32139320 DOI: 10.1016/j.dhjo.2020.100909] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Women with disabilities experience significant health disparities. A barrier to progress in addressing these disparities is the lack of population-based data on their health outcomes, which are needed to plan health care delivery systems. Administrative health data are increasingly being used to measure the health of entire populations, but these data may only capture impairment and not activity and participation restrictions. OBJECTIVE We conducted a systematic review to identify and appraise existing literature on the development and validation of algorithms to identify reproductive-aged women with physical and sensory disabilities in administrative health data. METHODS We searched Medline, EMBASE, CINAHL, PsycINFO, and Scopus from inception to April 2019 for studies of the development and/or validation of algorithms using diagnostic, procedural, or prescription codes to identify physical and sensory disabilities in administrative health data. Study and algorithm characteristics were extracted and quality was assessed using standardized instruments. RESULTS Of 14,073 articles initially identified, we reviewed 6 articles representing 2 unique algorithms. One algorithm aimed to correlate diagnoses, procedure codes, and prescriptions with ability to access routine care as an indicator of functional limitation. The other algorithm used diagnostic and procedure codes to identify use of mobility-assistive devices to measure functional limitation. Only one algorithm was validated against self-reported disability. CONCLUSIONS Our findings underscore the need to strengthen current methods to identify disability in administrative health data, including linkage with other sources of information on functional limitations, so that population-based data can be used to optimize health care for women with disabilities.
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16
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Clements KM, Zhang J, Long-Bellil LM, Mitra M. Emergency department utilization during the first year of life among infants born to women at risk of disability. Disabil Health J 2020; 13:100831. [DOI: 10.1016/j.dhjo.2019.100831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 07/10/2019] [Accepted: 07/24/2019] [Indexed: 11/30/2022]
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17
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Krahn GL. A Call for Better Data on Prevalence and Health Surveillance of People With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:357-375. [PMID: 31568742 DOI: 10.1352/1934-9556-57.5.357] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The U.S. approach to the health of people with intellectual and developmental disabilities (IDD) is fraught with paradox. The health of this population has been of longstanding concern, yet we understand their health less well than many other groups. The U.S. spends much more per person on the well-being of people with IDD compared to the general population, yet the outcomes of those expenditures are disappointing and include significant preventable health disparities. Even as expectations for people with IDD have changed to include better health and greater participation in their communities, eligibility for services that support these outcomes is rooted in expectations of dependence and poverty. This article is a call for better data that considers a series of questions to provide context for understanding the need and directions for better health surveillance of people with IDD.
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Affiliation(s)
- Gloria L Krahn
- Gloria L. Krahn, Oregon State University, College of Public Health and Human Sciences, Corvallis
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18
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Hall JP, Kurth NK, Gimm G, Smith S. Perspectives of adults with disabilities on access to health care after the ACA: Qualitative findings. Disabil Health J 2019; 12:350-358. [DOI: 10.1016/j.dhjo.2019.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/17/2022]
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19
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Iezzoni LI, Wint AJ, Tishler L, Palmisano J, Tripodis Y. Using claims for long-term services and support to predict mortality and hospital use. Disabil Health J 2019; 12:523-527. [PMID: 30956088 DOI: 10.1016/j.dhjo.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/30/2019] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Despite limitations in their clinical content, claims data from administering health plans can provide important insights about service use and outcomes across large populations. However, using claims data to investigate care and outcomes among persons with disability is challenging because standard diagnosis, procedure, and medication codes provide little information about functional impairments or disability. OBJECTIVE To explore whether supportive services claims provide useful information for predicting health care outcomes among persons with chronic disease and disability. METHODS We used administrative data from a nonprofit, Massachusetts health plan, including members who were 21 years of age and older and dually-eligible for Medicare and Medicaid. With procedure codes, we identified long-term services and supports and ventilator and percutaneous endoscopic gastrostomy supplies. Data from calendar year 2015 were used to predict deaths and hospitalizations in 2016. Hazards ratio analyses predicted these outcomes adjusting for age, sex, disease burden, and amount of personal assistance and homemaker services used (proxy functional status measure). RESULTS In bivariate analyses, all four predictors were statistically significant for both outcomes. In the full model, the proxy functional status measure did not statistically significantly predict hospitalization or death. After eliminating disease burden from the model, the proxy functional status measure became statistically significant, with hazards ratios of 1.006 for hospitalization (p = 0.0011) and 1.014 (p = <0.0001) for death. CONCLUSIONS Claims for supportive services could be proxies for disability in analyses using administrative data, but additional research must demonstrate their usefulness for predicting health care outcomes.
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Affiliation(s)
- Lisa I Iezzoni
- Mongan Institute Health Policy Center, Massachusetts General Hospital, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Amy J Wint
- Mongan Institute Health Policy Center, Massachusetts General Hospital, USA
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20
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Nunes DP, Brito TRPD, Giacomin KC, Duarte YADO, Lebrão ML. Performance pattern of activities of daily living for older adults in the city of São Paulo in 2000, 2006, and 2010. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 21Suppl 02:e180019. [PMID: 30726364 DOI: 10.1590/1980-549720180019.supl.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/20/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Functionality in aging is associated with the autonomy and independence of older people. OBJECTIVE To identify and hierarchize the difficulties reported by older adults in performing activities of daily living. METHOD This is a cross-sectional, descriptive, household-based study that used the Health, Well-being, and Aging Study (Saúde, Bem-Estar e Envelhecimento - SABE) database of 2000, 2006, and 2010. We evaluated the functionality using reports on the difficulty in performing basic and instrumental activities of daily living (ADL and IADL, respectively). The Guttman scaling assessed the hierarchy of functional impairment. RESULTS The prevalence of reported difficulty in performing one or more IADLs was 35.4, 45.8, and 41.0%; while for ADLs, it was 16.3, 13.3, and 17.5%, in 2000, 2006, and 2010, respectively. In ten years of follow-up, the variability in prevalence among women ranged from 42.3 to 54.6% for IADL impairment, and 17.0 to 20.4% for ADL. For men, it varied from 25.6 to 33.1% for IADL impairment, and 8.0 to 13.7% for ADL. In the three waves, the activities with the highest reported difficulty were using transportation, performing heavy tasks, and managing finances, while feeding was the least prevalent. CONCLUSION The prevalence of functional impairment increased in ten years, with higher variability among women and with advancing age. These results contribute to the planning of services and adequate distribution of existing resources as they reveal the needs and care required.
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Affiliation(s)
| | | | | | | | - Maria Lúcia Lebrão
- Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
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21
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New PW, Guilcher SJT, Jaglal SB, Biering-Sørensen F, Noonan VK, Ho C. Trends, Challenges, and Opportunities Regarding Research in Non-traumatic Spinal Cord Dysfunction. Top Spinal Cord Inj Rehabil 2018; 23:313-323. [PMID: 29339907 DOI: 10.1310/sci2304-313] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Spinal cord dysfunction (SCDys) is caused by heterogeneous health conditions, and the incidence is increasing. Despite the growing interest in rehabilitation research for SCDys, research into SCDys faces many challenges. Objective: The objective of this project was to perform a clinical review of changes in SCDys research over the last 4 decades; identify challenges to conducting research in SCDys; and propose opportunities for improving research in SCDys. Methods: A triangulation approach was used for obtaining evidence: literature search (January 2017) using MEDLINE and Embase databases for publications in English (1974-2016) regarding SCDys; workshop discussions at the International Spinal Cord Society annual meeting, September 16, 2016, Vienna, Austria; and our collective expertise in SCDys clinical rehabilitation research. Results: There has been a substantial increase in publications on SCDys over the 4 decades, from 1,825 in 1974-1983 to 11,887 in the decade 2004-2013, along with an improvement in research methodology. Numerous challenges to research in SCDys rehabilitation were grouped into the following themes: (a) identification of cases; (b) study design and data collection; and (c) funding, preclinical, and international research. Opportunities for addressing these were identified. Conclusions: The increase in scientific publications on SCDys highlights the importance of this heterogeneous group among the research community. The overall lack of good quality epidemiological studies regarding incidence, prevalence, and survival in these patients serves as a benchmark for guiding improvements to inform evidence-based care and policy.
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Affiliation(s)
- Peter Wayne New
- Spinal Rehabilitation Service, Department of Rehabilitation, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia.,Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto. Ontario, Canada.,Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Neuroscience Center, Rigshospitalet, University of Copenhagen, Denmark
| | | | - Chester Ho
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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McDermott S, Royer J, Cope T, Lindgren S, Momany E, Lee JC, McDuffie MJ, Lauer E, Kurtz S, Armour BS. Using Medicaid Data to Characterize Persons With Intellectual and Developmental Disabilities in Five U.S. States. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2018; 123:371-381. [PMID: 29949427 DOI: 10.1352/1944-7558-123.4.371] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This project sought to identify Medicaid members with intellectual and developmental disabilities (IDD) in five states (Delaware, Iowa, Massachusetts, New York, and South Carolina) to develop a cohort for subsequent analyses of medical conditions and service utilization. We estimated that over 300,000 Medicaid members in these states had IDD. All members with diagnostic codes for IDD were identified and the three most frequent diagnoses were unspecified intellectual disability, autism or pervasive developmental disorder, and cerebral palsy. The percentage of Medicaid members with IDD ranged from 2.3% in New York to 4.2% in South Carolina. Identifying and characterizing people with IDD is a first step that could guide public health promotion efforts for this population.
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Affiliation(s)
| | - Julie Royer
- Julie Royer, South Carolina Revenue and Fiscal Affairs Office
| | - Tara Cope
- Tara Cope, New York State Department of Health
| | - Scott Lindgren
- Scott Lindgren, The University of Iowa Carver College of Medicine
| | | | - Jae Chul Lee
- Jae Chul Lee and Mary Joan McDuffie, University of Delaware
| | | | - Emily Lauer
- Emily Lauer and Stephen Kurtz, University of Massachusetts Medical School; and
| | - Stephen Kurtz
- Emily Lauer and Stephen Kurtz, University of Massachusetts Medical School; and
| | - Brian S Armour
- Brian S. Armour, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
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Clements KM, Mitra M, Zhang J. Antenatal Hospital Utilization Among Women at Risk for Disability. J Womens Health (Larchmt) 2018; 27:1026-1034. [PMID: 29924659 DOI: 10.1089/jwh.2017.6543] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about the effect of potentially disabling health conditions on healthcare utilization during pregnancy. Using hospital discharge data, we identified women at risk for disability and evaluated antenatal hospital utilization, including emergency department (ED), observational stay (OS), and inpatient (IP) visits, by underlying health condition. MATERIALS AND METHODS Massachusetts Pregnancy to Early Life Longitudinal data system linked 2007-2009 birth certificates to 2006-2009 discharges. Access Risk Classification System categorized ICD-9-CM/Current Procedural Terminology codes recorded at delivery into disability risk groups (no/low vs. medium/high). Women were further categorized based on delivery diagnoses. Cox models evaluated the association between disability risk and utilization. Utilization by prenatal care and visit reason was examined. RESULTS Of 221,867 women, 4.0% were at medium/high risk of disability. Mental illness (26.9%) and circulatory system (25.2%) diagnoses were most common. More than 2% had comorbid mental/physical conditions. Women at risk for disability were more likely than women not at risk to have an antenatal ED (37.1% vs. 25.0%), OS (19.1% vs. 13.1%), or nondelivery IP visit (11.5% vs. 4.0%) (p ≤ 0.001 for each). Utilization varied by diagnosis. In adjusted analyses, women with two or more physical conditions had highest rate of ED visit (hazard ratio [HR] = 2.3, 95% confidence interval 1.8-2.8) and OS/IP visit (HR = 2.9, 95% 2.3-3.6) compared with women not at risk. Inadequate prenatal care was associated with increased utilization across all disability risk groups. ED visits for mental illness were high across groups. CONCLUSIONS Disability risk identified in discharge data is associated with elevated antenatal hospital utilization. Utilization varies by underlying diagnosis.
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Affiliation(s)
- Karen M Clements
- 1 Center for Health Policy and Research, University of Massachusetts Medical School , Shrewsbury, Massachusetts.,2 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
| | - Monika Mitra
- 3 Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | - Jianying Zhang
- 3 Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
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24
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de Hollander EL, Proper KI. Physical activity levels of adults with various physical disabilities. Prev Med Rep 2018; 10:370-376. [PMID: 29755934 PMCID: PMC5944414 DOI: 10.1016/j.pmedr.2018.04.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 03/16/2018] [Accepted: 04/21/2018] [Indexed: 11/30/2022] Open
Abstract
This study examined the physical activity (PA) levels of people with specific disabilities, using health care registration data. Data of 321,656 adults (83%) from the Dutch Public Health Monitor 2012 were used to assess adherence to the World Health Organization (WHO) PA guidelines (%) and the time (min/week) spent on moderate-to-vigorous-intensity and vigorous-intensity PA. Specific physical and sensory (i.e. vision and hearing) disabilities were identified by means of two health claims registries that include reimbursement of functional aids and long-term care. Generalized estimated equations were used to determine the association of PA with disabilities, adjusted for confounders (model 1) and additionally for self-reported activity limitations (model 2). Adults with disabilities had lower levels of WHO PA guidelines adherence (range: -49.8% to -11.9%, p < 0.01) and of moderate-to-vigorous-intensity PA (range: -691 to -200 min/week, p < 0.01) than adults without physical and sensory disabilities. Adults with physical disabilities had the lowest levels. The difference in levels of vigorous-intensity PA between adults with and without physical and sensory disabilities ranged from -12 to 8 min/week Only adults receiving long-term care due to physical disabilities had significantly lower vigorous-intensity PA levels (-12 min/week, p < 0.01). After adjustment for self-reported activity limitations, the difference in PA levels between adults with and without physical and sensory disabilities attenuated, especially among those with physical disabilities, but PA levels were still lower for adults with physical disabilities (-34.5% to -9.8% and -466 to -172 min/week, p < 0.01, respectively). Regardless of self-reported activity limitations, adults with objectively measured disabilities, especially those with physical disabilities, had lower PA levels compared to adults without physical and sensory disabilities.
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Affiliation(s)
- Ellen L de Hollander
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands
| | - Karin I Proper
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands
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25
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Gulley SP, Rasch EK, Bethell CD, Carle AC, Druss BG, Houtrow AJ, Reichard A, Chan L. At the intersection of chronic disease, disability and health services research: A scoping literature review. Disabil Health J 2018; 11:192-203. [PMID: 29396271 PMCID: PMC5869152 DOI: 10.1016/j.dhjo.2017.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND There is a concerted effort underway to evaluate and reform our nation's approach to the health of people with ongoing or elevated needs for care, particularly persons with chronic conditions and/or disabilities. OBJECTIVE This literature review characterizes the current state of knowledge on the measurement of chronic disease and disability in population-based health services research on working age adults (age 18-64). METHODS Scoping review methods were used to scan the health services research literature published since the year 2000, including medline, psycINFO and manual searches. The guiding question was: "How are chronic conditions and disability defined and measured in studies of healthcare access, quality, utilization or cost?" RESULTS Fifty-five studies met the stated inclusion criteria. Chronic conditions were variously defined by brief lists of conditions, broader criteria-based lists, two or more (multiple) chronic conditions, or other constructs. Disability was generally assessed through ADLs/IADLs, functional limitations, activity limitations or program eligibility. A smaller subset of studies used information from both domains to identify a study population or to stratify it by subgroup. CONCLUSIONS There remains a divide in this literature between studies that rely upon diagnostically-oriented measures and studies that instead rely on functional, activity or other constructs of disability to identify the population of interest. This leads to wide ranging differences in population prevalence and outcome estimates. However, there is also a growing effort to develop methods that account for the overlap between chronic disease and disability and to "segment" this heterogeneous population into policy or practice relevant subgroups.
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Affiliation(s)
- Stephen P Gulley
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA; National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, USA.
| | - Elizabeth K Rasch
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, USA
| | | | - Adam C Carle
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Amy J Houtrow
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Leighton Chan
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, USA
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Friedman DJ, Parrish RG, Fox MH. A Review of Global Literature on Using Administrative Data to Estimate Prevalence of Intellectual and Developmental Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018; 15:43-62. [PMID: 29681966 DOI: 10.1111/jppi.12220] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As understanding of health deficits among people with intellectual and developmental disabilities (IDD) increases, concerns grow about how to develop comprehensive, sustainable surveillance systems to reliably monitor the health of this population over time. This study reviews literature from 12 countries in which retrospective administrative data have been used to estimate population-based prevalence of IDD, identifies promising practices in that literature, and discusses the feasibility of applying those promising practices to other countries. Administrative data sources can be used to identify the number of people with IDD (numerators) in the presence of population estimates from which people with IDD are drawn (denominators) for discrete geographic locations. Case ascertainment methods, age groupings, data years captured, and other methods vary, contributing to a wide variation in prevalence rates. Six methods are identified from five countries that appear to offer the greatest likelihood of expanded applications. Approaches in which administrative data collections are linked with other population-based data sources appear promising as a means of estimating the size and characteristics of populations living with IDD in defined geographic locations. They offer the potential for sustainability, timeliness, accuracy, and efficiency.
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Affiliation(s)
| | - R Gibson Parrish
- Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael H Fox
- Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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27
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Epidemiology of Injury-Related Emergency Department Visits in the US Among Youth with Autism Spectrum Disorder. J Autism Dev Disord 2017; 46:2756-2763. [PMID: 27241347 DOI: 10.1007/s10803-016-2820-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Several reports suggest children with autism spectrum disorder (ASD) are more likely to be seen for injury-related ED visits; however, no nationally representative study has examined this question. Using data from the 2008 Nationwide Emergency Department Sample, over a quarter of all visits among those with ASD were related to injury. In the multivariate analyses, the odds of an injury-related visit was 54 % greater among those with ASD compared to youth with intellectual disability (ID), but 48 % less compared to youth without ID or ASD. Compared to all other pediatric injury-visits in the US, visits among children with ASD were more likely to be due to self-inflicted injury and poisoning and were more likely to result in hospitalization (all p < 0.001).
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McKenzie K, Martin L, Ouellette-Kuntz H. Needles in the haystack: Using open-text fields to identify persons with intellectual and developmental disabilities in administrative home care data. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 69:85-95. [PMID: 28841496 DOI: 10.1016/j.ridd.2017.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/29/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Use of administrative health data to study populations of interest is becoming more common. Identifying individuals with intellectual and developmental disabilities (IDD) in existing databases can be challenging due to inconsistent definitions and terminologies of IDD over time and across sectors, and the inability to rely on etiologies of IDD as they are frequently unknown. AIMS To identify diagnoses related to IDD in an administrative database and create a cohort of persons with IDD. METHODS Open-text diagnostic entries related to IDD were identified in an Ontario home care database (2003-2015) and coded as being either acceptable (e.g. Down syndrome) or ambiguous (e.g. intellectually challenged). The cognitive and functional skills of the resulting groups were compared using logistic regressions and standardized differences, and their age distributions were compared to that of the general home care population. RESULTS Just under 1% of the home care population had a diagnostic entry related to IDD. Ambiguous terms were most commonly used (61%), and this group tended to be older and less impaired than the group with more acceptable terms used to describe their IDD. CONCLUSIONS Open-text diagnostic variables in administrative health records can be used to identify and study individuals with IDD. IMPLICATIONS Future work is needed to educate assessors on the importance of using standard, accepted terminology when recording diagnoses related to IDD.
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Affiliation(s)
- Katherine McKenzie
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7 B 5E1, Canada.
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7 B 5E1, Canada.
| | - Hélène Ouellette-Kuntz
- Department of Public Health Sciences, Queen's University & Ongwanada, 191 Portsmouth Avenue, Kingston, Ontario, Kingston, K7 M 8A6, Canada.
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Soliman AM, Taylor H, Bonafede M, Nelson JK, Castelli-Haley J. Incremental direct and indirect cost burden attributed to endometriosis surgeries in the United States. Fertil Steril 2017; 107:1181-1190.e2. [DOI: 10.1016/j.fertnstert.2017.03.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/14/2017] [Accepted: 03/21/2017] [Indexed: 01/15/2023]
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Smith MG, Royer J, Mann J, McDermott S, Valdez R. Capture-recapture methodology to study rare conditions using surveillance data for fragile X syndrome and muscular dystrophy. Orphanet J Rare Dis 2017; 12:76. [PMID: 28427448 PMCID: PMC5399384 DOI: 10.1186/s13023-017-0628-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare conditions can be catastrophic for families and the implications for public health can be substantial. Our study compared basic surveillance through active medical record review with a linked administrative data file to assess the number of cases of two rare conditions, fragile X syndrome (FXS) and muscular dystrophy (MD) in a population. METHODS Two methods of data collection were used to collect information from five counties comprising two standard metropolitan statistical areas of South Carolina. The passive system relied mostly on health claims data using ICD-9 CM diagnostic codes. The active system relied on a nurse abstracting records from a list of all licensed physicians with specialties in neurology, orthopedics, and genetics. RESULTS There were 141 FXS cases and 348 MD cases that met the case definitions using active surveillance. Additional cases were found for both conditions but they were determined to not be true cases. After linking the actively collected MD and FXS cases to passive datasets, we found that the estimated total numbers of cases were similar to using capture-recapture analysis; the positive predictive values for cases identified in the passive system were 56.6% for MD and 75.7% for FXS. CONCLUSIONS Applying capture-recapture methods to passively collected surveillance data for rare health conditions produced an estimate of the number of true cases that was similar to that obtained through active data collection.
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Affiliation(s)
- Michael G Smith
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA.
| | - Julie Royer
- Revenue and Fiscal Affairs Office, Health and Demographics Section, Columbia, SC, USA
| | - Joshua Mann
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Suzanne McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Rodolfo Valdez
- Centers for Disease Control and Prevention, National Center for Birth Defects and Developmental Disabilities, Atlanta, GA, USA
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Schiltz NK, Warner DF, Sun J, Bakaki PM, Dor A, Given CW, Stange KC, Koroukian SM. Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: An Analytic Approach. Med Care 2017; 55:276-284. [PMID: 27753745 PMCID: PMC5309172 DOI: 10.1097/mlr.0000000000000660] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood. OBJECTIVE The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization. DESIGN Retrospective cohort study using the Health and Retirement Study (2008-2010) linked to Medicare claims. Analysis used machine-learning techniques: classification and regression trees and random forest. SUBJECTS A population-based sample of 5771 Medicare-enrolled adults aged 65 and older in the United States. MEASURES Main covariates: self-reported chronic conditions (measured as none, mild, or severe), geriatric syndromes, and functional limitations. Secondary covariates: demographic, social, economic, behavioral, and health status measures. OUTCOMES Medicare expenditures in the top quartile and inpatient utilization. RESULTS Median annual expenditures were $4354, and 41% were hospitalized within 2 years. The tree model shows some notable combinations: 64% of those with self-rated poor health plus activities of daily living and instrumental activities of daily living disabilities had expenditures in the top quartile. Inpatient utilization was highest (70%) in those aged 77-83 with mild to severe heart disease plus mild to severe diabetes. Functional limitations were more important than many chronic diseases in explaining resource use. CONCLUSIONS The multimorbid population is heterogeneous and there is considerable variation in how specific combinations of morbidity influence resource use. Modeling the conjoint effects of chronic conditions, functional limitations, and geriatric syndromes can advance understanding of groups at greatest risk and inform targeted tailored interventions aimed at cost containment.
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Affiliation(s)
- Nicholas K Schiltz
- *Department of Epidemiology & Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH †Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE ‡Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC §Department of Family Medicine, Michigan State University, East Lansing, MI ∥Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH
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Ajmera M, Shen C, Sambamoorthi U. Concomitant Medication Use and New-Onset Diabetes Among Medicaid Beneficiaries with Chronic Obstructive Pulmonary Disease. Popul Health Manag 2016; 20:224-232. [PMID: 27689453 DOI: 10.1089/pop.2016.0047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Use of multiple prescription medications is common among individuals with chronic obstructive pulmonary disease (COPD) because of coexisting inflammatory-related conditions. Specifically, the use of antidepressants, inhaled corticosteroids (ICSs), and statins may place individuals with COPD at high risk for new-onset diabetes. The objective was to examine the relationship between the use of antidepressants, ICSs, and statins and new-onset diabetes among Medicaid beneficiaries with COPD. This study used a retrospective longitudinal cohort design using multiple years (2005-2008) of Medicaid claims for beneficiaries with newly diagnosed COPD (n = 15,287), who were diabetes free at baseline. National Drug Codes were used to determine the receipt of antidepressants, ICSs, and statins, and International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to define new-onset diabetes (250.x2). Multivariable logistic regression was used to examine the adjusted relationship between medication use and new-onset diabetes. Overall, 6.3% of the study population was diagnosed with new-onset diabetes. After controlling for baseline characteristics, individuals using ICSs (adjusted odds ratio [AOR]: 1.23; 95% confidence interval [CI]: 1.07, 1.47) or statins (AOR: 1.48; 95% CI: 1.27, 1.72) had a greater risk of new-onset diabetes compared to those not given ICSs, statins, or antidepressants. Analyses using combined medication categories revealed that adults using statins in combination with both antidepressants and ICSs, or when combined with ICS, were more likely to have new-onset diabetes. These findings indicate that multiple medication use (ICSs and statins) was associated with increased rates of new-onset diabetes. Further research is warranted to understand this association.
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Affiliation(s)
- Mayank Ajmera
- 1 RTI Health Solutions, Research Triangle Park , North Carolina
| | - Chan Shen
- 2 Departments of Health Services Research and Biostatistics, University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Usha Sambamoorthi
- 3 Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University , Morgantown, West Virginia
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Clements KM, Mitra M, Zhang J, Iezzoni LI. Pregnancy Characteristics and Outcomes among Women at Risk for Disability from Health Conditions Identified in Medical Claims. Womens Health Issues 2016; 26:504-10. [PMID: 27477954 DOI: 10.1016/j.whi.2016.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Women with disabilities are at risk for poor birth outcomes. Little is known about specific potentially disabling health conditions and their effects on pregnancies. Using hospital claims, we identified women at risk for disability and evaluated the relationship between disability risk and demographic characteristics, pregnancy risks, and infant and maternal outcomes. METHODS The 2006 through 2009 Massachusetts Pregnancy to Early Life Longitudinal data system linked birth certificate and hospital claims one year pre-pregnancy through delivery. Access Risk Classification System categorized International Classification of Diseases, Ninth Revision, Clinical Modification/Current Procedural Terminology codes into disability risk groups (no/limited vs. medium/high). Generalized estimating equations evaluated the association between disability risk and infant and maternal outcomes. RESULTS Of 221,867 women, 14,701 (6.6%) were at medium or high risk of disability. Health conditions were classified as circulatory (23%), musculoskeletal (10%), nervous system/sensory (13%), other physical (19%), two or more physical (5%), mental illness (24%), and comorbid mental/physical (6%). Women at risk of disability were more likely than others to have socioeconomic and pregnancy risks, and adverse infant and maternal outcomes. Socioeconomic and risk profile varied by health condition category. Adjusted risk ratios for preterm birth ranged from 1.2 (95% confidence interval [CI], 1.1-1.4) for women with nervous system/sensory diagnoses to 1.6 (95% CI, 1.4-1.9) for women with two or more physical diagnoses; risk ratios for maternal delivery hospitalization for more than 5 days ranged from 1.5 (95% CI, 1.2-1.9) for women with musculoskeletal diagnoses to 3.0 (95% CI, 2.5-3.6) for women with comorbid mental/physical diagnoses. CONCLUSIONS Disability risk identified through claims is associated with poor infant and maternal outcomes. Risk profiles vary by underlying health condition.
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Affiliation(s)
- Karen M Clements
- Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, Massachusetts; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Jianying Zhang
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lisa I Iezzoni
- The Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
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Koroukian SM, Schiltz N, Warner DF, Sun J, Bakaki PM, Smyth KA, Stange KC, Given CW. Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes. J Gen Intern Med 2016; 31:630-7. [PMID: 26902246 PMCID: PMC4870414 DOI: 10.1007/s11606-016-3590-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/16/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health. OBJECTIVE We aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. DESIGN, SETTING AND PARTICIPANTS Data from the 2010-2012 Health and Retirement Study provided a representative sample of U.S. adults 50 years of age or older (n = 16,640). MAIN MEASURES Outcomes were: Self-reported fair/poor health, self-rated worse health at 2 years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes. KEY RESULTS Twenty-nine percent and 23 % of respondents reported fair/poor health and self-rated worse health at 2 years, respectively, and 5 % died in 2 years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80 %); b) for self-rated worse health at 2 years: 68.5 years of age or older, difficulty walking several blocks and being in fair/poor health (60 %); and c) for 2-year mortality: 80.5 years of age or older, and presenting with limitations in both ADLs and IADLs (> 40 %). CONCLUSIONS Rather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.
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Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4945, USA.
| | - Nicholas Schiltz
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4945, USA
| | - David F Warner
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Jiayang Sun
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4945, USA
| | - Paul M Bakaki
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4945, USA
| | - Kathleen A Smyth
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4945, USA
| | - Kurt C Stange
- Department of Family Medicine and Community Health, School of Medicine, Epidemiology and Biostatistics, Sociology, Case Comprehensive Cancer Center, Cleveland Clinical & Translational Science Collaborative, Case Western Reserve University, Cleveland, OH, USA
| | - Charles W Given
- Department of Family Medicine, Michigan State University, East Lansing, MI, USA
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Slayter E. Disparities in Substance Abuse Treatment Utilization Among Women with Intellectual Disability. ACTA ACUST UNITED AC 2016; 15:96-115. [PMID: 26958802 DOI: 10.1080/1536710x.2016.1162120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite concerns about health disparities among women with intellectual disabilities, little is known about substance abuse treatment access in this population. Using standardized performance measures, treatment initiation and engagement were examined retrospectively for women aged 18 to 64 (N = 3,752), men with (N = 5,732) and women without intellectual disability (N = 493,446). Logistic regression models of utilization were conducted. Women in the sample were less likely than men in the sample or women without intellectual disability to utilize treatment, suggesting both gender-related and disability-related barriers. Policy and practice implications for improving the health and welfare of women with intellectual disabilities are discussed.
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Affiliation(s)
- Elspeth Slayter
- a Graduate School of Social Work , Salem State University , Salem , Massachusetts , USA
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Chrischilles EA, Schneider KM, Schroeder MC, Letuchy E, Wallace RB, Robinson JG, Brooks JM. Association Between Preadmission Functional Status and Use and Effectiveness of Secondary Prevention Medications in Elderly Survivors of Acute Myocardial Infarction. J Am Geriatr Soc 2016; 64:526-35. [PMID: 26928940 DOI: 10.1111/jgs.13953] [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] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine whether function-related indicators (FRIs), derived from preadmission claims data, help explain the frequent practice of forgoing secondary prevention medications observed in Medicare. DESIGN Retrospective cohort. SETTING National Medicare data. PARTICIPANTS Elderly Medicare beneficiaries discharged alive from an acute myocardial infarction (AMI) hospitalization in 2007-2008 (N = 184,156). MEASUREMENTS Study outcomes were number of guideline-recommended secondary prevention medications (statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) used after discharge and 12-month survival. Preadmission data (FRIs, cardiovascular conditions, comorbid conditions), type of AMI (non-ST-elevation myocardial infarction, anterior, other), and procedures and complications during the hospitalization were from claims data. RESULTS Function-related indicators (FRIs) were common before admission; 50% of individuals had at least one (range 0-11). After discharge, 85.8% used at least one class of guideline medication, and 30.2% used all three; 19.6% died within 12 months. Each additional FRI reduced the likelihood of receiving all three medication classes by 5% (adjusted odds ratio = 0.95, 95% confidence interval (CI) = 0.94-0.96) and increased 12-month mortality by 20% (adjusted hazard ratio (aHR) = 1.20, 95% CI = 1.19-1.21). Individuals taking all three classes of medication were 30% less likely to die within 12 months than those not taking guideline medications (aHR = 0.70, 95% CI = 0.67-0.73). Similar survival benefit was observed in individuals with and without functional impairments. CONCLUSION Greater impairment in preadmission functional status, using a measure derived from claims data, was associated with less use of secondary prevention medications after AMI. Survival benefits of taking these medications were consistent across functional impairment levels.
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Affiliation(s)
| | - Kathleen M Schneider
- Schneider Research Associates, LLC, Des Moines, Iowa.,Buccaneer, A General Dynamics Company, West Des Moines, Iowa
| | - Mary C Schroeder
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa
| | - Elena Letuchy
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Robert B Wallace
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Jennifer G Robinson
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - John M Brooks
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Ben-Shalom Y, Stapleton DC. Predicting Disability among Community-Dwelling Medicare Beneficiaries Using Claims-Based Indicators. Health Serv Res 2015; 51:262-81. [PMID: 26015332 DOI: 10.1111/1475-6773.12316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess the feasibility of using existing claims-based algorithms to identify community-dwelling Medicare beneficiaries with disability based solely on the conditions for which they are being treated, and improving on these algorithms by combining them in predictive models. DATA SOURCE Data on 12,415 community-dwelling fee-for-service Medicare beneficiaries who first responded to the Medicare Current Beneficiary Survey (MCBS) in 2003-2006. STUDY DESIGN Logistic regression models in which six claims-based disability indicators are used to predict self-reported disability. Receiver operating characteristic (ROC) curves were used to assess the performance of the predictive models. PRINCIPAL FINDINGS The predictive performance of the regression-based models is better than that of the individual claims-based indicators. At a predicted probability threshold chosen to maximize the sum of sensitivity and specificity, sensitivity is 0.72 for beneficiaries age 65 or older and specificity is 0.65. For those under 65, sensitivity is 0.54 and specificity is 0.67. The findings also suggest ways to improve predictive performance for specific disability populations of interest to researchers. CONCLUSIONS Predictive models that incorporate multiple claims-based indicators provide an improved tool for researchers seeking to identify people with disabilities in claims data.
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Rabadi MH, Vincent AS. Factors predictive of type of powered mobility received by veterans with disability. Med Sci Monit 2015; 21:1324-32. [PMID: 25955214 PMCID: PMC4436948 DOI: 10.12659/msm.893438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The goal of this observational study was to determine factors predictive of the type of powered mobility prescribed to veterans with disability. Material/Methods A retrospective chart review was conducted for all veterans (n=170) who received powered mobility from a designated power mobility clinic. Logistic regression analysis was used to determined factors predictive of the type of powered mobility provided. Results Sixty-four (38%) veterans were provided powered wheelchairs and 106 (62%) were provided powered scooters. Of the variables examined, only primary medical conditions for referral and disability severity (as measured by the 2-minute timed walk test; 2-MWT) were predictive of the types of powered mobility prescribed. Veterans who were able to walk longer distances were more likely to be prescribed powered scooters. Age, gender, race, level of education, marital and employment status, number of chronic medical conditions, and upper and lower limb muscle strength were not significant predictors. Conclusions This study suggests that the primary medical conditions for referral and 2-MWT can assist clinicians in the determination of the type of powered mobility to prescribe to veterans with disability.
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Affiliation(s)
- Meheroz H Rabadi
- Department of Neurology, Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andrea S Vincent
- Cognitive Science Research Center, University of Oklahoma at Norman, Norman, OK, USA
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Lin E, Balogh R, Isaacs B, Ouellette-Kuntz H, Selick A, Wilton AS, Cobigo V, Lunsky Y. Strengths and Limitations of Health and Disability Support Administrative Databases for Population-Based Health Research in Intellectual and Developmental Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2015. [DOI: 10.1111/jppi.12098] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth Lin
- Centre for Addiction and Mental Health; Toronto Canada
| | - Robert Balogh
- University of Ontario Institute of Technology; Oshawa Canada
| | | | | | - Avra Selick
- Centre for Addiction and Mental Health; Toronto Canada
| | | | | | - Yona Lunsky
- Centre for Addiction and Mental Health; Toronto Canada
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Disparities in health care utilization by race among teenagers and young adults with muscular dystrophy. Med Care 2014; 52:S32-9. [PMID: 25215918 DOI: 10.1097/mlr.0000000000000194] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND For people with muscular dystrophy (MD) health care access is crucial and utilization is expected to be high. A multidisciplinary approach is needed for optimal management of symptoms of this rare condition. Regular primary care, specialty care, therapy, and medicine use can improve quality of care and reduce need for emergency treatment and hospitalization. We analyzed health insurance and administrative data to test for racial disparities in regular care use among teenagers and young adults with MD. METHODS We used South Carolina Medicaid and other administrative data for individuals aged 15-24 years to determine annual health care utilization patterns for individuals with MD by race. We studied adolescents and young adults with MD because this age group represents a time when the condition is typically intensifying and the transition from pediatric to adult care is expected. We used Generalized Estimating Equation models to analyze longitudinal utilization data conditional on other factors that may lead to utilization differences. RESULTS Race is correlated with health care utilization among adolescents and young adults with MD. Blacks have lower overall utilization, and less primary care, therapy, and specialist care use but higher incidence of hospitalization and emergency treatment use compared with whites and also to other races. The most striking disparity was the use of outpatient services. Blacks utilized these services 50% less compared with whites and 70% less compared with others. Even in regression analysis, where we take into account individual unobserved factors and allow clustering at the individual level, these differences remained and were in most cases statistically significant. CONCLUSIONS Our results indicate that there are differences in health care utilization by race even when individuals have access to the same health care benefits. This means simply offering coverage to individuals with MD may not be sufficient in eliminating health disparities. Future studies will be needed to examine other possible sources of these racial disparities, such as resource awareness, health knowledge, or access barriers such as transportation.
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Wilkinson J, Lauer E, Greenwood NW, Freund KM, Rosen AK. Evaluating representativeness and cancer screening outcomes in a state department of developmental services database. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:136-146. [PMID: 24725112 DOI: 10.1352/1934-9556-52.2.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Though it is widely recognized that people with intellectual and developmental disabilities (IDD) face significant health disparities, the comprehensive data sets needed for population-level health surveillance of people with IDD are lacking. This paucity of data makes it difficult to track and accurately describe health differences, improvements, and changes in access. Many states maintain administrative health databases that, to date, have not been widely used for research purposes. In order to evaluate the feasibility of using administrative databases for research purposes, the authors attempted to validate Massachusetts' administrative health database by comparing it to a large safety net hospital system's patient data regarding cancer screening, and to the state's service enrollment tables. The authors found variable representativeness overall; the sub-population of adults who live in 24-hr supported residences were better represented than adults who live independently or with family members. They also found a fairly low false negative rate for cancer screening data as compared with the "gold standard" of hospital records. Despite some limitations, these results suggest that state-level administrative databases may represent an exciting new avenue for health research. These results should lend context to efforts to study cancer and health screening variables using administrative databases. The present study methods may also have utility to researchers in other states for critically evaluating other state IDD service databases. This type of evaluation can assist researchers in contextualizing their data, and in tailoring their research questions to the abilities and limitations of this kind of database.
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Iezzoni LI. Disability as a covariate in risk adjustment models for predicting hospital deaths. Ann Epidemiol 2013; 24:17-22. [PMID: 24262999 DOI: 10.1016/j.annepidem.2013.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 03/03/2013] [Accepted: 10/19/2013] [Indexed: 10/26/2022]
Abstract
Risk-adjusted hospital mortality rates are frequently used as putative indicators of hospital quality. These figures could become increasingly important as efforts escalate to contain U.S. health care costs while simultaneously maintaining or improving quality of care. Most risk adjustment methods today employ coded diagnostic information sometimes supplemented with more detailed clinical data obtained from medical records. This article considers whether risk-adjusted hospital mortality rates should account for baseline patient disability. Accounting for baseline disability when calculating hospital mortality rates makes clinical sense, especially for conditions such as heart failure or coronary artery bypass grafting surgery, where patients' cardiac-related functional status strongly predicts their imminent outcomes. A small body of research suggests the strength of disability in predicting hospital mortality, even in comparison with indicators of acute physiologic status and comorbid illness. However, the feasibility of obtaining complete and accurate data on patients' baseline disability will be challenging and requires further investigation. The risk of not adjusting for baseline disability could be efforts by physicians and hospitals to avoid treating patients with significant disabilities.
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Affiliation(s)
- Lisa I Iezzoni
- Mongan Institute for Health Policy, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA.
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Gutgesell HP, Hillman DG, McHugh KE, Dean P, Matherne GP. Use of an administrative database to determine clinical management and outcomes in congenital heart disease. World J Pediatr Congenit Heart Surg 2013; 2:593-6. [PMID: 23804472 DOI: 10.1177/2150135111414065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We review our 16-year experience using the large, multi-institutional database of the University HealthSystem Consortium to study management and outcomes in congenital heart surgery for hypoplastic left heart syndrome, transposition of the great arteries, and neonatal coarctation. The advantages, limitations, and use of administrative databases by others to study congenital heart surgery are reviewed.
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Affiliation(s)
- Howard P Gutgesell
- Department of Pediatrics, Division of Cardiology, University of Virginia Health System, Charlottesville, VA, USA
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Anema HA, Kievit J, Fischer C, Steyerberg EW, Klazinga NS. Influences of hospital information systems, indicator data collection and computation on reported Dutch hospital performance indicator scores. BMC Health Serv Res 2013; 13:212. [PMID: 23758921 PMCID: PMC3698115 DOI: 10.1186/1472-6963-13-212] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 05/15/2013] [Indexed: 11/24/2022] Open
Abstract
Background For health care performance indicators (PIs) to be reliable, data underlying the PIs are required to be complete, accurate, consistent and reproducible. Given the lack of regulation of the data-systems used in the Netherlands, and the self-report based indicator scores, one would expect heterogeneity with respect to the data collection and the ways indicators are computed. This might affect the reliability and plausibility of the nationally reported scores. Methods We aimed to investigate the extent to which local hospital data collection and indicator computation strategies differ and how this affects the plausibility of self-reported indicator scores, using survey results of 42 hospitals and data of the Dutch national quality database. Results The data collection and indicator computation strategies of the hospitals were substantially heterogenic. Moreover, the Hip and Knee replacement PI scores can be regarded as largely implausible, which was, to a great extent, related to a limited (computerized) data registry. In contrast, Breast Cancer PI scores were more plausible, despite the incomplete data registry and limited data access. This might be explained by the role of the regional cancer centers that collect most of the indicator data for the national cancer registry, in a standardized manner. Hospitals can use cancer registry indicator scores to report to the government, instead of their own locally collected indicator scores. Conclusions Indicator developers, users and the scientific field need to focus more on the underlying (heterogenic) ways of data collection and conditional data infrastructures. Countries that have a liberal software market and are aiming to implement a self-report based performance indicator system to obtain health care transparency, should secure the accuracy and precision of the heath care data from which the PIs are calculated. Moreover, ongoing research and development of PIs and profound insight in the clinical practice of data registration is warranted.
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Affiliation(s)
- Helen A Anema
- Department of Public Health, Academic Medical Center- University of Amsterdam, Room: J2-211, P,O, Box 22660, Amsterdam NL-1100 DD, The Netherlands.
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Lin E, Balogh R, Cobigo V, Ouellette-Kuntz H, Wilton AS, Lunsky Y. Using administrative health data to identify individuals with intellectual and developmental disabilities: a comparison of algorithms. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:462-477. [PMID: 23116328 DOI: 10.1111/jir.12002] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Individuals with intellectual and developmental disabilities (IDD) experience high rates of physical and mental health problems; yet their health care is often inadequate. Information about their characteristics and health services needs is critical for planning efficient and equitable services. A logical source of such information is administrative health data; however, it can be difficult to identify cases with IDD in these data. The purpose of this study is to evaluate three algorithms for case finding of IDD in health administrative data. METHODS The three algorithms were created following existing approaches in the literature which ranged between maximising sensitivity versus balancing sensitivity and specificity. The broad algorithm required only one IDD service contact across all available data and time periods, the intermediate algorithm added the restriction of a minimum of two physician visits while the narrow algorithm added a further restriction that the time period be limited to 2006 onward. The resulting three cohorts were compared according to socio-demographic and clinical characteristics. Comparisons on different subgroups for a hypothetical population of 50,000 individuals with IDD were also carried out: this information may be relevant for planning specialised treatment or support programmes. RESULTS The prevalence rates of IDD per 100 were 0.80, 0.52 and 0.18 for the broad, intermediate and narrow algorithms, respectively. Except for 'percentage with psychiatric co-morbidity', the three cohorts had similar characteristics (standardised differences < 0.1). More stringent thresholds increased the percentage of psychiatric co-morbidity and decreased the percentages of women and urban residents in the identified cohorts (standardised differences = 0.12 to 0.46). More concretely, using the narrow algorithm to indirectly estimate the number of individuals with IDD, a practice not uncommon in planning and policy development, classified nearly 7000 more individuals with psychiatric co-morbidities than using the intermediate algorithm. CONCLUSIONS The prevalence rate produced by the intermediate algorithm most closely approximated the reported literature rate suggesting the value of imposing a two-physician visit minimum but not restricting the time period covered. While the statistical differences among the algorithms were generally minor, differences in the numbers of individuals in specific population subgroups may be important particularly if they have specific service needs. Health administrative data can be useful for broad-based service planning for individuals with IDD and for population level comparisons around their access and quality of care.
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Affiliation(s)
- E Lin
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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Shireman TI, Reichard A, Hunt SL. Learning your ABDs: variation in health care utilization across Kansas Medicaid disability groups. Disabil Health J 2013; 6:220-6. [PMID: 23769481 DOI: 10.1016/j.dhjo.2013.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 01/10/2013] [Accepted: 02/06/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND State Medicaid programs provide critical health care access for persons with disabilities and older adults. Aged, Blind and Disabled (ABD) programs consist of important disability subgroups that Medicaid programs are not able to readily distinguish. OBJECTIVE/HYPOTHESIS The purpose of this project was to create an algorithm based principally on eligibility and claims data to distinguish disability subgroups and characterize differences in demographic characteristics, disease burden, and health care expenditures. METHODS We created an algorithm to distinguish Kansas Medicaid enrollees as adults with intellectual or developmental delays (IDD), physical disabilities (PD), severe mental illness (SMI), and older age. RESULTS For fiscal year 2009, our algorithm separated 101,464 ABD enrollees into the following disability subgroups: persons with IDD (19.6%), persons with PD (21.0%), older adults (19.7%), persons with SMI (32.8%), and persons not otherwise classified (6.9%). The disease burden present in the IDD, PD, and SMI subgroups was higher than for older adults. Home- and community-based services expenditures were common and highest for persons with IDD and PD. Older adults and persons with SMI had their highest expenditures for long-term care. Mean Medicaid expenditures were consistently higher for adults with IDD followed by adults with PD. CONCLUSIONS There are substantial differences between disability subgroups in the Kansas Medicaid ABD population with respect to demographics, disease burden, and health care expenditures. Through this algorithm, state Medicaid programs have the opportunity to collaborate with the most closely aligned service providers reflecting needed services for each disability subgroup.
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Affiliation(s)
- Theresa I Shireman
- Preventive Medicine & Public Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., MSN 1008, Kansas City, KS 66160, USA.
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Balogh RS, Ouellette-Kuntz H, Brownell M, Colantonio A. Factors associated with hospitalisations for ambulatory care-sensitive conditions among persons with an intellectual disability: a publicly insured population perspective. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:226-239. [PMID: 22369576 DOI: 10.1111/j.1365-2788.2011.01528.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Hospitalisations for ambulatory care-sensitive (ACS) conditions are used as an indicator of access to, and the quality of, primary care. The objective was to identify factors associated with hospitalisations for ACS conditions among adults with an intellectual disability (ID) in the context of a publicly insured healthcare system. METHODS This study examined adults with an ID living in a Canadian province between 1999 and 2003 identified from administrative databases. Using 5 years of data for the study population, characteristics of persons hospitalised or not hospitalised for ACS conditions were compared. Using a conceptual model, independent variables were selected and an analysis performed to identify which were associated with hospitalisations for ACS conditions. The correlated nature of the observations was accounted for statistically. RESULTS Living in a rural area [odds ratio (OR) 1.3; 95% confidence intervals (CI) = 1.0, 1.8], living in an area with a high proportion of First Nations people (OR 2.3; 95% CI = 1.3, 4.1), and experiencing higher levels of comorbidity (OR 25.2; 95% CI = 11.9, 53.0) were all associated with a higher likelihood of being hospitalised for an ACS condition. Residing in higher income areas had a protective effect (OR 0.56; 95% CI = 0.37, 0.85). None of the health service resource variables showed statistically significant associations. CONCLUSIONS Persons with an ID experience inequity in hospitalisations for ACS conditions according to rurality, income and proportion who are First Nations in a geographic area. This suggests that addressing the socio-economic problems of poorer areas and specifically areas densely populated by First Nations people may have an impact on the number of hospitalisations for ACS conditions. Study strengths and limitations and areas for potential future research are discussed.
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Affiliation(s)
- R S Balogh
- Dual Diagnosis Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Khoury AJ, Hall A, Andresen E, Zhang J, Ward R, Jarjoura C. The association between chronic disease and physical disability among female Medicaid beneficiaries 18-64 years of age. Disabil Health J 2012; 6:141-8. [PMID: 23507165 DOI: 10.1016/j.dhjo.2012.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 11/06/2012] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Rates of physical disability are higher in women than in men, and economically disadvantaged women are at greater risk for physical disability than women with higher incomes. Chronic diseases increase the risk of physical disability, and people with physical disability experience some added risks of secondary conditions including chronic disease. Yet, little is known about the prevalence of chronic disease among women living with a physical disability who use Medicaid, a particularly disadvantaged population. OBJECTIVE This study described the prevalence of chronic disease among adult (18-64 years), female, Florida Medicaid beneficiaries living with a physical disability between 2001 and 2005. METHODS Using Medicaid eligibility and claims files, we extracted ICD-9 codes for physically-disabling conditions and Current Procedure Terminology codes for mobility-assistive devices to define three levels of physical disability. RESULTS Participants appeared to be at high risk for both physical disability and chronic diseases. Close to half of the women had been diagnosed with one or more physically-disabling conditions, and 5.3% used mobility devices. One-third of the women had hypertension and sizeable proportions had other chronic diseases. Women with physical disability were more likely to have co-morbid chronic diseases than their able-bodied counterparts. DISCUSSION Our findings support the need for improved chronic disease prevention among female Medicaid beneficiaries, particularly those with physical disability. Strategies to improve prevention, screening and treatment in this population may mitigate the trends toward higher physical disability rates in the low-income, working-age population and may prevent high Medicare and Medicaid costs in the long-run.
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Affiliation(s)
- Amal J Khoury
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
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Gold R, Angier H, Mangione-Smith R, Gallia C, McIntire PJ, Cowburn S, Tillotson C, DeVoe JE. Feasibility of evaluating the CHIPRA care quality measures in electronic health record data. Pediatrics 2012; 130:139-49. [PMID: 22711724 PMCID: PMC3382922 DOI: 10.1542/peds.2011-3705] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) includes provisions for identifying standardized pediatric care quality measures. These 24 "CHIPRA measures" were designed to be evaluated by using claims data from health insurance plan populations. Such data have limited ability to evaluate population health, especially among uninsured people. The rapid expansion of data from electronic health records (EHRs) may help address this limitation by augmenting claims data in care quality assessments. We outline how to operationalize many of the CHIPRA measures for application in EHR data through a case study of a network of >40 outpatient community health centers in 2009-2010 with a single EHR. We assess the differences seen when applying the original claims-based versus adapted EHR-based specifications, using 2 CHIPRA measures (Chlamydia screening among sexually active female patients; BMI percentile documentation) as examples. Sixteen of the original CHIPRA measures could feasibly be evaluated in this dataset. Three main adaptations were necessary (specifying a visit-based population denominator, calculating some pregnancy-related factors by using EHR data, substituting for medication dispense data). Although it is feasible to adapt many of the CHIPRA measures for use in outpatient EHR data, information is gained and lost depending on how numerators and denominators are specified. We suggest first steps toward application of the CHIPRA measures in uninsured populations, and in EHR data. The results highlight the importance of considering the limitations of the original CHIPRA measures in care quality evaluations.
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Affiliation(s)
- Rachel Gold
- aKaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA.
| | | | | | - Charles Gallia
- Oregon Division of Medical Assistance Programs, Portland, Oregon; and
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Carroll Chapman SL, Wu LT. Substance abuse among individuals with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1147-56. [PMID: 22502840 PMCID: PMC3328139 DOI: 10.1016/j.ridd.2012.02.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 02/09/2012] [Indexed: 05/24/2023]
Abstract
Individuals with disabilities are a growing population that confronts multiple disadvantages from social and environmental determinants of health. In particular, the 7-8 million people in the U.S. with an intellectual disability (ID) suffer disproportionately from substance use problems, largely because of a lack of empirical evidence to inform prevention and treatment efforts for them. Although available research could inform future research efforts, studies are scattered across disciplines with the last review synthesizing findings written more than five years ago. To consider more recent findings with earlier works, PubMed, PsychINFO, and Google Scholar were searched and produced 37 peer-reviewed texts across multiple disciplines, 15 from 2006 or later. While the prevalence of alcohol and illicit drug use in this population are low, the risk of having a substance-related problem among ID substance users is comparatively high. Gaps in the research and population subgroups that warrant special attention are identified, such as individuals with borderline and mild ID, individuals with co-occurring mental illness, and individuals who are incarcerated. Compared with substance abusers without ID, ID substance abusers are less likely to receive substance abuse treatment or remain in treatment. Research is needed to better gauge the magnitude of substance use problems, identify prevention strategies, and specify treatment components that meet the unique needs of individuals with ID.
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Affiliation(s)
- Shawna L Carroll Chapman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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