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Rotoli J, Sapp R, Poffenberger C, Mirus IV, Moreland C, Balhara K, Gipson K, Backster A, Modi P, Donnelly C, Coates WC. Words matter: Language impact on the care of patients with disabilities. Am J Emerg Med 2024; 82:205-208. [PMID: 38937223 DOI: 10.1016/j.ajem.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024] Open
Affiliation(s)
- Jason Rotoli
- Emergency Medicine, University of Rochester, United States of America.
| | - Richard Sapp
- Emergency Medicine Resident PGY-3, Harvard Affiliated Emergency Medicine Residency at Mass General Brigham, United States of America
| | - Cori Poffenberger
- Emergency Medicine, University of New Mexico, United States of America
| | - I V Mirus
- Emergency Medicine, UT Southwestern, United States of America
| | | | - Kamna Balhara
- Emergency Medicine, Johns Hopkins University School of Medicine, United States of America
| | - Katrina Gipson
- Emergency Medicine, Emory School of Medicine, United States of America
| | - Anika Backster
- Emergency Medicine, Emory School of Medicine, United States of America
| | - Payal Modi
- Emergency Medicine, UMass Chan Medical School
| | - Cullan Donnelly
- Emergency Medicine Resident PGY-2, University of Rochester, United States of America
| | - Wendy C Coates
- Emergency Medicine, University of California, Los Angeles David Geffen School of Medicine, United States of America
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Haque M, Gaspari S, Bobbette N, Walker M, Bartels SA. "Pain is not typically taken into consideration due to him being nonverbal"- emergency department experiences among persons with disabilities: a mixed methods study in Kingston, Ontario. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1353120. [PMID: 39119263 PMCID: PMC11306198 DOI: 10.3389/fresc.2024.1353120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
Background Persons with disabilities (PWD) are more likely to visit the emergency department (ED) and often have complex health needs when accessing care in the ED. Yet there is limited understanding of ED care experiences among PWD, especially in a Canadian context. The aim of this study was to examine the ED care experiences of PWD in contrast to a comparison group in Kingston, Ontario to better understand their health care needs. Methods A mixed-methods study with a community-based participatory approach examining participants' past ED care experiences (within 24 months) was conducted in Kingston, ON. Quantitative data from those with disabilities and those from the comparison group were compared using chi squared tests to identify differences between groups. An inductive and deductive thematic analysis approach was used to identify themes in the shared qualitative data. Convergence of findings across quantitative and qualitative data was undertaken. Results A total of 175 participants identified as having a disability. In contrast with the comparison group (N = 949), PWD were more likely to report being given too little attention to their needs (p < 0.001), that it was more important to be treated with kindness/respect than to receive the best possible medical care (p < 0.001), to report feelings of disrespect and/or judgement (p < 0.001), and that better understanding of personal identity/situation/culture and better communication would improve ED care. Qualitative analysis highlighted the following themes: poor communication between PWD and health care providers (HCP), compassionate medical care received, perceived HCP negative attitudes/beliefs related to having a disability and substance misuse, and perceived HCP lack of knowledge/skill to treat the unique health needs of PWD. Conclusion Findings highlight the need to improve ED care for PWD. Future quality improvement initiatives should focus on incorporating a deeper understanding of disability into medical education and emergency medicine (EM) residency education, designing curricula that emphasize cultural humility, and implementing community-based placements providing opportunities for health professionals to work with and learn from PWD.
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Affiliation(s)
- Minha Haque
- Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Sierra Gaspari
- Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Nicole Bobbette
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Melanie Walker
- Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Susan A. Bartels
- Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
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Hamadah K, Velagapudi M, Navarro JJ, Pirotte A, Obersteadt C. Best Practices for Treating Blind and Visually Impaired Patients in the Emergency Department: A Scoping Review. West J Emerg Med 2024; 25:350-357. [PMID: 38801041 PMCID: PMC11112656 DOI: 10.5811/westjem.61686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/21/2023] [Accepted: 01/19/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Blind and visually impaired individuals, an under-represented population of the emergency department (ED), possess comorbidities and have a higher chance of in-hospital sequelae, including falls. This potentially vulnerable population, if not treated mindfully, can be subject to decreased quality of care, recurrent and/or longer hospitalizations, persistence of health issues, increased incidence of falls, and higher healthcare costs. For these reasons, it is crucial to implement holistic practices and train clinicians to treat blind and visually impaired patients in the ED setting. Methods We identified and used a comprehensive article describing best practices for the care of blind and visually impaired patients to establish the ED-specific recommendations presented in this paper. A scoping review of the literature was then performed using PubMed to identify additional articles to support each recommendation. To ensure that recommendations could be implemented in a representative, scalable, and sustainable manner, we consulted an advocate for the blind to help refine and provide additional suggestions. Results We identified 14 recommendations that focus on communication strategies, ED resource access, and continuity of care. The main recommendation is for the clinician to support the unique healthcare needs of the visually impaired individual and maintain the patient's autonomy. Another recommendation is the consistent use of assistive devices (eg, canes, guide dogs) to aid patients to safely ambulate in the ED. Also identified as best practices were discharge education with the use of a screen reader and timely follow-up with a primary care physician. Conclusion While we summarize a variety of recommendations in this article, it is important to implement only the strategies that work best for the patients, personnel, and environment specific to your ED. After implementation, it is vital to refine (as frequently as needed) the interventions to optimize the strategies. This will enable the provision of exceptional and equal care to blind and visually impaired patients in the ED.
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Affiliation(s)
- Kareem Hamadah
- University of Kansas School of Medicine, Kansas City, Kansas
- University of Kansas Medical Center, Kansas City, Kansas
| | - Mary Velagapudi
- University of Kansas Health System, Kansas City, Kansas
- University of Kansas Medical Center, Kansas City, Kansas
| | - Juliana J. Navarro
- University of Kansas Health System, Kansas City, Kansas
- University of Kansas Medical Center, Kansas City, Kansas
| | - Andrew Pirotte
- University of Kansas Health System, Kansas City, Kansas
- University of Kansas Medical Center, Kansas City, Kansas
- University of Kansas Medical Center, Department of Emergency Medicine, Kansas City, Kansas
- University of Kansas Medical Center, Office of Student Affairs, Kansas City, Kansas
| | - Chris Obersteadt
- University of Kansas Health System, Kansas City, Kansas
- University of Kansas Medical Center, Kansas City, Kansas
- Rockhurst University, Kansas City, Kansas
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Conner KR, Jones CM, Wood N, Aldalur A, Paracha M, Powell SJ, Nie Y, Dillon KM, Rotoli J. Use of Routine Emergency Department Care Practices with Deaf American Sign Language Users. J Emerg Med 2023; 65:e163-e171. [PMID: 37640633 PMCID: PMC10653031 DOI: 10.1016/j.jemermed.2023.05.001] [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: 08/12/2022] [Revised: 04/20/2023] [Accepted: 05/26/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Deaf individuals who communicate using American Sign Language (ASL) seem to experience a range of disparities in health care, but there are few empirical data. OBJECTIVE To examine the provision of common care practices in the emergency department (ED) to this population. METHODS ED visits in 2018 at a U.S. academic medical center were assessed retrospectively in Deaf adults who primarily use ASL (n = 257) and hearing individuals who primarily use English, selected at random (n = 429). Logistic regression analyses adjusted for confounders compared the groups on the provision or nonprovision of four routine ED care practices (i.e., laboratories ordered, medications ordered, images ordered, placement of peripheral intravenous line [PIV]) and on ED disposition (admitted to hospital or not admitted). RESULTS The ED encounters with Deaf ASL users were less likely to include laboratory tests being ordered: adjusted odds ratio 0.68 and 95% confidence interval 0.47-0.97. ED encounters with Deaf individuals were also less likely to include PIV placement, less likely to result in images being ordered in the ED care of ASL users of high acuity compared with English users of high acuity (but not low acuity), and less likely to result in hospital admission. CONCLUSION Results suggest disparate provision of several types of routine ED care for adult Deaf ASL users. Limitations include the observational study design at a single site and reliance on the medical record, underscoring the need for further research and potential reasons for disparate ED care with Deaf individuals.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York; Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Courtney M Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Nancy Wood
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York; Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Mariam Paracha
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York; Department of Science and Mathematics, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, New York
| | - Stephen J Powell
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Yunbo Nie
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Kevin M Dillon
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Jason Rotoli
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
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Park S, Park JH. Disability and Emergency Department Visits: A Path Analysis of the Mediating Effects of Unmet Healthcare Needs and Chronic Diseases. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231182863. [PMID: 37335048 DOI: 10.1177/00469580231182863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Previous studies identified disabilities and unmet healthcare needs, especially those related to primary healthcare, as predictors of ED use. This study examined the relationship between disability, unmet healthcare needs, chronic diseases, and ED visits in South Korea. This study was a cross-sectional study using the Korean Health Panel Survey collected in 2018. A path analysis was used. Our research found a significant association between disability and ED visits mediated by unmet healthcare needs and chronic diseases. Disability had a significant direct effect on unmet healthcare needs (β = .04, P ≤ .001) and chronic diseases (β = .10, P ≤ .001). However, there was no mediating effect of unmet healthcare needs between disability and ED visits. While barriers to access to care among people with disabilities are widely acknowledged, this study suggests that interventions or programs to reduce ED visits should consider the unique healthcare needs of people with disabilities.
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Cluster Analysis of the Highest Users of Medical, Behavioral Health, and Social Services in San Francisco. J Gen Intern Med 2022; 38:1143-1151. [PMID: 36447066 PMCID: PMC9708142 DOI: 10.1007/s11606-022-07873-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND In the City and County of San Francisco, frequent users of emergent and urgent services across different settings (i.e., medical, mental health (MH), substance use disorder (SUD) services) are referred to as high users of multiple systems (HUMS). While often grouped together, frequent users of the health care system are likely a heterogenous population composed of subgroups with differential management needs. OBJECTIVE To identify subgroups within this HUMS population using a cluster analysis. DESIGN Cross-sectional study of HUMS patients for the 2019-2020 fiscal year using the Coordinated Care Management System (CCMS), San Francisco Department of Public Health's integrated data system. PARTICIPANTS We calculated use scores based on nine types of urgent and emergent medical, MH, and SUD services and identified the top 5% of HUMS patients. Through k-medoids cluster analysis, we identified subgroups of HUMS patients. MAIN MEASURES Subgroup-specific demographic, comorbidity, and service use profiles. KEY RESULTS The top 5% of HUMS patients in the study period included 2657 individuals; 69.7% identified as men and 66.5% identified as non-White. We detected 5 subgroups: subgroup 1 (N = 298, 11.2%) who were relatively younger with prevalent MH and SUD comorbidities, and MH services use; subgroup 2 (N = 478, 18.0%), who were experiencing homelessness, with multiple comorbidities, and frequent use of medical services; subgroup 3 (N = 449, 16.9%), who disproportionately self-identified as Black, with prolonged homelessness, multiple comorbidities, and persistent HUMS status; subgroup 4 (N = 690, 26.0%), who were relatively older, disproportionately self-identified as Black, with prior homelessness, multiple comorbidities, and frequent use of medical services; and subgroup 5 (N=742, 27.9%), who disproportionately self-identified as Latinx, were housed, with medical comorbidities and frequent medical service use. CONCLUSIONS Our study highlights the heterogeneity of HUMS patients. Interventions must be tailored to meet the needs of these diverse patient subgroups.
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Doolub G, Kobo O, Sharma G, Paul TK, Diaz-Arocutipa C, Ullah W, Myint PK, Mamas M. Outcomes of acute myocardial infarction in patients with preexisting physical disability: a report in the United States. Expert Rev Cardiovasc Ther 2022; 20:851-859. [DOI: 10.1080/14779072.2022.2138858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Gemina Doolub
- Bristol Heart Institute, Bristol, UK
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Ofer Kobo
- Keele Cardiovascular Research Group, Keele University, Keele, UK
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Garima Sharma
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins School of Me dicine, Baltimore, MD, USA
| | - Timir K Paul
- Department of Medical Education, University of Tennessee at Nashville, Nashville, TN, USA
| | | | - Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Phyo K Myint
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, UK
- Aberdeen Cardiovascular & Diabetes Centre (ACDC), Institute of Medical Sciences, University of Aberdeen, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
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Sapp RW, Sebok‐Syer SS, Gisondi MA, Rotoli JM, Backster A, McClure Poffenberger C. The Prevalence of Disability Health Training and Residents With Disabilities in Emergency Medicine Residency Programs. AEM EDUCATION AND TRAINING 2021; 5:e10511. [PMID: 33898914 PMCID: PMC8053000 DOI: 10.1002/aet2.10511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Individuals with disabilities experience significant health care disparities due to a multitude of barriers to effective care, which include a lack of adequate physician training on this topic and negative attitudes of physicians. This results in disparities through inadequate physical examination and diagnostic testing, withholding or inferior treatment, and neglecting preventative care. While much has been published about disability education in undergraduate medical education, little is known about the current state of disability education in emergency medicine (EM) residency programs. METHODS In 2019, a total of 237 EM residency program directors (PDs) in the United States were surveyed about the actual and desired number of hours of disability health instruction, perceived barriers to disability health education, prevalence of residents and faculty with disabilities, and confidence in providing accommodations to residents with disabilities. RESULTS A total of 104 surveys were completed (104/237, 43.9% response rate); 43% of respondents included disability-specific content in their residency curricula for an average of 1.5 total hours annually, in contrast to average desired hours of 4.16 hours. Reported barriers to disability health education included lack of time and lack of faculty expertise. A minority of residency programs have faculty members (13.5%) or residents (26%) with disabilities. The prevalence of EM residents with disabilities was 4.02%. Programs with residents with disabilities reported more hours devoted to disability curricula (5 hours vs 1.54 hours, p = 0.017) and increased confidence in providing workplace accommodations for certain disabilities including mobility disability (p = 0.002), chronic health conditions (p = 0.022), and psychological disabilities (p = 0.018). CONCLUSIONS A minority of EM PDs in our study included disability health content in their residency curricula. The presence of faculty and residents with disabilities is associated with positive effects on training programs, including a greater number of hours devoted to disability health education and greater confidence in accommodating learners with disabilities. To reduce health care disparities for patients with disabilities, we recommend that a dedicated disability health curriculum be integrated into all aspects of the EM residency curriculum, including lectures, journal clubs, and simulations and include direct interaction with individuals with disabilities. We further recommend that disability be recognized as an aspect of diversity when hiring faculty and recruiting residents to EM programs, to address this training gap and to promote a diverse and inclusive learning environment.
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Affiliation(s)
| | | | - Michael A. Gisondi
- Department of Emergency MedicineStanford University School of MedicineStanfordCAUSA
| | - Jason M. Rotoli
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNYUSA
| | - Anika Backster
- Department of Emergency MedicineEmergency NeurosciencesEmory UniversityAtlantaGAUSA
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Rotoli J, Backster A, Sapp RW, Austin ZA, Francois C, Gurditta K, Mirus C, McClure Poffenberger C. Emergency Medicine Resident Education on Caring for Patients With Disabilities: A Call to Action. AEM EDUCATION AND TRAINING 2020; 4:450-462. [PMID: 33150294 PMCID: PMC7592824 DOI: 10.1002/aet2.10453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 05/07/2023]
Abstract
People with disabilities constitute a marginalized population who experience significant health care disparities resulting from structural, socioeconomic, and attitudinal barriers to accessing health care. It has been reported that education on the care of marginalized groups helps to improve awareness, patient-provider rapport, and patient satisfaction. Yet, emergency medicine (EM) residency education on care for people with disabilities may be lacking. The goal of this paper is to review the current state of health care for patients with disabilities, review the current state of undergraduate and graduate medical education on the care of patients with disabilities, and provide suggestions for an improved EM residency curriculum that includes education on the care for patients with disabilities.
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Blaskowitz MG, Hernandez B, Scott PW. Predictors of Emergency Room and Hospital Utilization Among Adults With Intellectual and Developmental Disabilities (IDD). INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:127-145. [PMID: 30920909 DOI: 10.1352/1934-9556-57.2.127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Emergency room (ER) and hospital utilization among people with intellectual and developmental disabilities (IDD) are significant contributors to rising healthcare costs. This study identifies predictors of utilization among 597 adults with IDD. Using a retrospective survey of medical charts, descriptive statistics and logistic regressions were conducted. Individual-level risk factors for ER utilization included age, number of chronic health conditions, a diagnosis of cerebral palsy or neurological disorder, mental illness, and polypharmacy. Environmental predictors included community-based supported living. Hospitalization predictors included age and number of chronic illnesses. People residing in group homes were less likely to be admitted. This study found risk factors unique to individuals with IDD that should be addressed with tailored interventions as states transition to Medicaid managed care.
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Affiliation(s)
- Meghan G Blaskowitz
- Meghan G. Blaskowitz, Duquesne University, Department of Occupational Therapy; Brigida Hernandez, YAI Network; and Paul W. Scott, University of Pittsburgh, Department of Health and Community Systems
| | - Brigida Hernandez
- Meghan G. Blaskowitz, Duquesne University, Department of Occupational Therapy; Brigida Hernandez, YAI Network; and Paul W. Scott, University of Pittsburgh, Department of Health and Community Systems
| | - Paul W Scott
- Meghan G. Blaskowitz, Duquesne University, Department of Occupational Therapy; Brigida Hernandez, YAI Network; and Paul W. Scott, University of Pittsburgh, Department of Health and Community Systems
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Health, Health Behaviors, and Health Care Utilization Among Adults with Serious Psychological Distress Who Receive Federal Housing Assistance. J Behav Health Serv Res 2019; 46:586-606. [PMID: 30684168 DOI: 10.1007/s11414-018-09647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Using newly available U.S. Department of Housing and Urban Development (HUD) administrative data linked with National Health Interview Survey (NHIS) data, this study estimates the prevalence of serious psychological distress (SPD) among non-elderly HUD-assisted adults and examines differences in health, health behaviors, and health care utilization for this population. The linked data estimate that 13% of HUD-assisted adults experience SPD. Controlling for individual characteristics and HUD program type, assisted housing residents who had SPD experienced higher rates of self-reported fair or poor health, chronic disease, and cigarette smoking than HUD-assisted adults without SPD. Adults with SPD had more frequent use of emergency rooms and were more likely than residents without SPD to have more frequent contact with specialists, general doctors, and mental health providers, although they also reported increased levels of unmet health care needs due to affordability. Policy implications are discussed.
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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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Kim AM, Lee JY, Kim J. Emergency department utilization among people with disabilities in Korea. Disabil Health J 2018; 11:598-605. [PMID: 29548565 DOI: 10.1016/j.dhjo.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/12/2018] [Accepted: 03/06/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND According to prior studies, it is possible to consider the emergency care utilization due to ambulatory care sensitive conditions (ACSCs) as a proxy measure of access to primary care but there was no confirmed study among people with disabilities. OBJECTIVE/HYPOTHESIS We examined overall emergency department (ED) utilization patterns among people with disabilities compared with the general population and estimated factors affecting ED utilization. Additionally, we examined whether there were any differences in ED visits due to ACSCs according to type and severity of disability. METHODS The nationally representative Korean Health Panel Survey was used. Data from 14,616 individuals who participated in the survey from 2008 to 2012 were analyzed. The frequency and causes of emergency visits were examined between individuals with and without disabilities. A generalized regression model with Poisson distribution was applied to identify factors that affect ED visits. RESULTS In 2012, people with disabilities were about two times as likely to visit the ED compared to people without disabilities, and people with external disability represented the largest proportion of people with disabilities. According to generalized linear model, disability was a strong predictor of ED visits, along with lower education level, being elderly, having a chronic disease, and being less healthy. Overall, ED visits due to ACSCs were about three times higher in the disabled group than in the non-disabled group. CONCLUSIONS Public health authorities should consider strengthening the primary care system to avoid unnecessary and preventable ED utilization among all Korean people, including people with disabilities.
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Affiliation(s)
- Agnus M Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Yong Lee
- Public Health Medical Service, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Jayeun Kim
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
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Schamess A, Foraker R, Kretovics M, Barnes K, Beatty S, Bose-Brill S, Tayal N. Reduced emergency room and hospital utilization in persons with multiple chronic conditions and disability receiving home-based primary care. Disabil Health J 2017; 10:326-333. [DOI: 10.1016/j.dhjo.2016.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/14/2016] [Accepted: 10/07/2016] [Indexed: 02/04/2023]
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Brucker DL. The association of food insecurity with health outcomes for adults with disabilities. Disabil Health J 2017; 10:286-293. [DOI: 10.1016/j.dhjo.2016.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/28/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
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Lofters A, Guilcher S, Maulkhan N, Milligan J, Lee J. Patients living with disabilities: The need for high-quality primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e457-e464. [PMID: 27521411 PMCID: PMC4982744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare the potential risk factors for lower-quality primary care, the potential markers of unmet needs in primary care, and the willingness to participate in future research among primary care patients with versus without physical disabilities. DESIGN A waiting room survey using a convenience sample. SETTING A family health team (FHT) in Kitchener-Waterloo, Ont, with a designated Mobility Clinic. PARTICIPANTS A total of 40 patients seen at the FHT Mobility Clinic and 80 patients from the general patient population of the same FHT. MAIN OUTCOME MEASURES Socioeconomic status and social capital, number of self-reported emergency department visits and hospitalizations in the preceding year, and willingness of the patients in the 2 groups to participate in future research studies. RESULTS Patients from the Mobility Clinic were more than twice as likely to be receiving benefits or social assistance (75.0% vs 32.1%, P < .001), were twice as likely to report an annual household income of less than $40000 (58.6% vs 29.2%, P = .006), and were more likely to report their health status to be fair or poor (42.5% vs 16.2%, P = .002). Half of Mobility Clinic patients had visited the emergency department at least once in the preceding year, compared with 29.7% in the general patient population (P = .027). When asked if they would be willing to provide their health card number in the future so that it could be linked to health care data for research, 82.5% of Mobility Clinic patients agreed versus 55.0% of those in the general patient population (P = .004). CONCLUSION In this study, patients with disabilities were at a social disadvantage compared with their peers without disabilities and were more likely to use the emergency department, suggesting that they had unmet health needs. Future research should continue to explore this patient population and to investigate if an interprofessional primary health care team approach focused on patients with disabilities can help to increase quality of care.
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Affiliation(s)
- Aisha Lofters
- Scientist with the Centre for Urban Health Solutions of the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto, Ont.
| | - Sara Guilcher
- Assistant Professor with the Leslie Dan Faculty of Pharmacy at the University of Toronto
| | - Niraj Maulkhan
- Research assistant with the Centre for Family Medicine Family Health Team at the time of this research
| | - James Milligan
- Family physician with the Centre for Family Medicine Family Health Team
| | - Joseph Lee
- Family physician with the Centre for Family Medicine Family Health Team
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What Are the Determinants of Specialized Outpatient and Dental Care Use in Adults With Disabilities Living in Institutions: Findings From a National Survey in France. Arch Phys Med Rehabil 2016; 97:1276-83. [PMID: 26903146 DOI: 10.1016/j.apmr.2016.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/27/2016] [Accepted: 01/30/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore the determinants of specialized outpatient care use (general practitioners excluded) in people with disabilities living in institutions. DESIGN Cross-sectional study. SETTING National health and disability survey. PARTICIPANTS People (N=2528) living in institutions for adults with cognitive, sensory, and mobility disabilities. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We used different measures of disability severity available in the survey: (1) the continuous score of limitations based on a measure we constructed according to self-reported level of difficulty performing 18 tasks without aid; (2) the Katz Index; and (3) the respondent's self-reported perception of functional limitations. Logistic regressions were performed to examine the determinants of the likelihood of having consulted a specialized outpatient care physician or a dentist at least once in the previous year. RESULTS Of the 2528 individuals, 45% (1141) and 28% (697) had respectively consulted a specialized outpatient care physician or a dentist at least once in the previous year. After adjusting for health care needs, higher functional limitation scores, dependency in all 6 activities of daily living, and self-reported perceptions of severe functional limitations were significantly associated with a lower likelihood of having consulted a specialized outpatient care physician (adjusted odds ratio [AOR], .95 [95% confidence interval {CI}, .94-.96]; AOR, .29 [95% CI, .23-.38]; and AOR, .51 [95% CI, .42-.62], respectively) or a dentist (AOR, .95 [95% CI, .94-.96]; AOR, .29 [95% CI, .21-.39]; AOR, .55 [95% CI, .44-.67], respectively) at least once in the previous year. Being a man, reporting a lack of family support, and having a low socioeconomic status also significantly affected specialized outpatient care use. CONCLUSIONS Regardless of the method used to define and measure disability, a high degree of disability negatively affects specialized outpatient care use after adjusting for health care need. Further studies are needed to better understand the reasons why this association between the degree of functional limitation and unmet medical needs is also a reality for people with disabilities living in institutions.
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Houlihan B, Brody M, Plant A, Skeels SE, Zazula J, Pernigotti D, Green C, Hasiotis S, Jette A. Health Care Self-Advocacy Strategies for Negotiating Health Care Environments: Analysis of Recommendations by Satisfied Consumers with SCI and SCI Practitioners. Top Spinal Cord Inj Rehabil 2016; 22:13-26. [PMID: 29398890 PMCID: PMC5790025 DOI: 10.1310/sci2201-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bethlyn Houlihan
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | - Miriam Brody
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | - Andrea Plant
- The Life Care Center of America, Plymouth, Massachusetts
| | - Sarah Everhart Skeels
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | - Judi Zazula
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | | | | | | | - Alan Jette
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
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Diagnosis isn't enough: Understanding the connections between high health care utilization, chronic conditions and disabilities among U.S. working age adults. Disabil Health J 2015; 8:535-46. [PMID: 26082321 DOI: 10.1016/j.dhjo.2015.04.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 04/04/2015] [Accepted: 04/23/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Under the ACA, new programs are being developed to enhance care coordination and reduce health care costs among people with chronic conditions, disabilities, and high utilization of health care. However, the relationships between these groups are not well understood. OBJECTIVES Our aims were to (1) identify high utilizers of health care in the U.S. working age (18-64) population, (2) examine the overlap between this group and people with chronic conditions and/or disabilities, (3) identify predictors of high service use or cost among these subpopulations, and (4) recommend approaches for stratification of individuals with high health care utilization. METHODS Using pooled national data from the Medical Expenditure Panel Survey (2006-2008), we created indices to identify elevated or high utilization and cost groups. We performed descriptive analyses, bivariate comparisons and multivariate analyses to examine the relations between these populations and individuals with chronic conditions and/or disabilities. RESULTS While the large majority of persons with high use/cost had chronic conditions, the minority of persons with chronic conditions had high health care utilization. However, among persons with chronic conditions, disability was a significant predictor of high utilization. Annual expenditures were significantly elevated among people with disabilities, particularly when activities of daily living were limited. CONCLUSIONS We conclude that medical diagnosis alone is insufficient for the development of eligibility criteria for, or the evaluation of, programs intended to better the delivery or coordination of services for high utilizers of health care services. New approaches are needed to assess functional limitations and identify ongoing needs for services and supports.
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Rogers K, Zeni MB. Systematic review of medical home models to promote transitions to primary adult health care for adolescents living with autism spectrum disorder. Worldviews Evid Based Nurs 2015; 12:98-107. [PMID: 25774018 DOI: 10.1111/wvn.12085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a growing number of children diagnosed and living with autism spectrum disorders (ASDs) in the United States. This increasing incidence and prevalence of ASDs require care coordination within a medical home model, which needs to continue into adulthood. AIM This paper is an evidence review of medical home models for transitioning adolescents living with ASDs from pediatric primary healthcare practices to adult primary care practices. METHOD Databases were reviewed and articles selected based on inclusion and exclusion criteria. RESULTS Nine articles were reviewed and four met criteria. None of the articles addressed medical home models to transition adolescents living with ASDs into adult primary healthcare services. LINKING EVIDENCE TO ACTION There is a need for nursing to work within an interdisciplinary framework to educate adult healthcare providers on the needs of adolescents living with ASDs and to evaluate medical home transition models for this vulnerable population.
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Affiliation(s)
- Kathleen Rogers
- Assistant Professor, Department of Nursing, Ursuline College, Pepper Pike, OH, USA
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Gulley SP, Rasch EK, Chan L. Difference, disparity, and disability: a comparison of health, insurance coverage, and health service use on the basis of race/ethnicity among US adults with disabilities, 2006-2008. Med Care 2014; 52:S9-16. [PMID: 25222647 PMCID: PMC4166572 DOI: 10.1097/mlr.0000000000000129] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United States, research on health disparities has begun to include people with disabilities as a minority population. However, there is a gap in our knowledge of whether, and to what extent, racial and ethnic disparities may affect the health or health care access of people with disabilities. OBJECTIVES We examined potential disparities in overall health, insurance coverage status, and health service use between non-Hispanic whites, non-Hispanic blacks, and Hispanics, among a nationally representative US sample of adults with and without disabilities (N=63,257), using both bivariate and multivariate methods. We tested 2 definitions of disparity. RESULTS Under the more conservative definition, we confirmed the presence of both racial and ethnic disparities in overall health, total annual health care visits, and the percentage reporting no doctor visit during the year among people with less severe disabilities; Hispanics also evidenced a disparity in rates uninsured relative to non-Hispanic whites in this group. Racial/ethnic disparities were less common among persons with more severe disabilities that affected activities of daily living or instrumental activities. CONCLUSIONS We conclude that the reduction of disparities between the populations of people with and without disabilities will require specific attention to racial and ethnic disparities in health, insurance coverage, and service use.
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Affiliation(s)
- Stephen P. Gulley
- Brandeis University, Waltham, MA
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD
| | - Elizabeth K. Rasch
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD
| | - Leighton Chan
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD
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Hunold KM, Richmond NL, Waller AE, Cutchin MP, Voss PR, Platts-Mills TF. Primary care availability and emergency department use by older adults: a population-based analysis. J Am Geriatr Soc 2014; 62:1699-706. [PMID: 25125087 DOI: 10.1111/jgs.12984] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the relationship between the number of primary care providers (PCPs) in an area and emergency department (ED) visits by older adults. DESIGN Population-based cross-sectional observational study. SETTING Nonfederal EDs in North Carolina in 2010. PARTICIPANTS All older adults (n = 640,086) presenting to a nonfederal ED in North Carolina in 2010. MEASUREMENTS The primary outcome was the number of ED visits by older adults in each ZIP code per 100 adults aged 65 and older living in that ZIP code. A secondary outcome was the number of ED visits not resulting in hospital admission per 100 older adults. The primary predictor variable was the number of PCPs per 100 older residents for each ZIP code. Covariates included those representing healthcare need (Medicare hospitalizations, nursing home beds), predisposing factors for healthcare use (race, education, population density of older adults), and enabling factors (distance to the nearest ED). RESULTS In a multivariable regression model corrected for spatial clustering, ZIP code characteristics associated with ED visits included more hospitalizations by Medicare beneficiaries, more nursing home beds, and closer proximity to an ED. Number of PCPs per 100 older adult residents in each ZIP code was not associated with ED use, and the 95% confidence limit indicates at most a small effect of PCP availability on ED use. CONCLUSION These findings suggest that primary care availability has at most a limited effect on ED use by older adults in North Carolina.
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Chi DL, Masterson EE, Wong JJ. U.S. emergency department admissions for nontraumatic dental conditions for individuals with intellectual and developmental disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:193-204. [PMID: 24937745 PMCID: PMC4097187 DOI: 10.1352/1934-9556-52.3.193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The authors hypothesized that individuals with intellectual and developmental disabilities (IDDs) are more likely to have an emergency department (ED) admission for nontraumatic dental conditions (NTDCs). The authors analyzed 2009 U.S. National Emergency Department Sample data and ran logistic regression models for children ages 3-17 years and adults age 18 years or older. The prevalence of NTDC-related ED admissions was 0.8% for children and 2.0% for adults. Children with IDDs were at increased odds of NTDC-related ED admission, but this difference was not statistically significant (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 0.91, 1.23). Adults with IDDs had significantly lower odds of an ED admission for NTDCs (OR = 0.49; 95% CI = 0.44, 0.54). Children with IDDs are not at increased odds of NTDC-related ED admissions, whereas adults with IDDs are at significantly reduced odds.
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Fox MH, Reichard A. Disability, health, and multiple chronic conditions among people eligible for both Medicare and Medicaid, 2005-2010. Prev Chronic Dis 2013; 10:E157. [PMID: 24050527 PMCID: PMC3780711 DOI: 10.5888/pcd10.130064] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction People who are eligible for both Medicare and Medicaid (dual eligibles) and who have disabilities and multiple chronic conditions (MCC) present challenges for treatment, preventive services, and cost-effective access to care within the US health system. We sought to better understand dual eligibles and their association with MCC, accounting for sociodemographic factors inclusive of functional disability category. Methods Medical Expenditure Panel Survey (MEPS) data for 2005 through 2010 were stratified by ages 18 to 64 and 65 or older to account for unique subsets of dual eligibles. Prevalence of MCC was calculated for those with physical disabilities, physical plus cognitive disabilities, and all others, accounting for sociodemographic and health-related factors. Adjusted odds for having MCC were calculated by using logistic regression. Results Of dual eligibles aged 18 to 64, 53% had MCC compared with 73.5% of those aged 65 or older. Sixty-five percent of all dual eligibles had 2 or more chronic conditions, and among dual eligibles aged 65 or older with physical disabilities and cognitive limitations, 35% had 4 or more, with hypertension and arthritis the most common conditions. Dual eligibles aged 18 to 64 who had a usual source of medical care had a 127% increased likelihood of having MCC compared with those who did not have a usual source of care. Conclusion Attention to disability can be a component to helping further understand the relationship between health and chronic conditions for dual eligible populations and other segments of our society with complex health and medical needs.
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Affiliation(s)
- Michael H Fox
- National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA.
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