| Date post: | 09-May-2018 |
| Category: |
Documents |
| Upload: | doannguyet |
| View: | 215 times |
| Download: | 2 times |
Disability and Rehabilitation Research Project: Health and
Health Care Disparities Among Individuals with
Disabilities (Health Disparities) Project Highlights
Charles E. Drum, MPA, JD, PhD,
Principal Investigator
December 3, 2014
Overview
• Acknowledgements
• Brief introduction to Health Disparities Project, including need and approach
• Introduction of Panel presentations
• Introduction of Panel members
12/3/2014 2
Acknowledgements
• Funded by the U.S. Department of Education, National Institute for Disability and Rehabilitation Research (NIDRR), grant #H133A080031 (2008-2010) & H133A100031 (2010-2014)
• 1 study collaborated with the Research and Training Center on Community Living grant #H133B11000
12/3/2014 3
Acknowledgements
• Health Disparities & Disability Expert Panel: Glenn Fujiura, PhD, Lisa Iezzoni, MD, MSc, Gloria Krahn, PhD, MPH, Elena Andresen, PhD, and Charles E. Drum, MPA, JD, PhD (Chair)
12/3/2014 4
Acknowledgements
Core project staff included:
• UNH Research Team
• OHSU Research Team
• Pacific University
Additional project staff from University of Kansas, RTC on Community Living
12/3/2014 5
Project Need: NIDRR
• Growing body of research on health and health care disparities experienced by persons with disabilities
• Need research on factors that explain disparities within different disability groups
• Factors that explain disparities may include systems level (e.g., insurance payer type, provider type), environmental level (e.g., urban/rural), or individual level (e.g., disability type, severity, SES, race and ethnicity)
12/3/2014 6
Project Approach
Systematic scoping reviews:
• Health outcomes among disability subgroups
• Health care utilization among disability subgroups
• Scoping reviews are a rigorous, systematic method for locating and reviewing previously published research
12/3/2014 7
Project Approach
Secondary data analysis studies:
• Pooled data from the Medical Expenditure Panel Survey (MEPS) (2002-2008; 2004-2010)
• Factors that relate to health and health care disparities among different disability groups
12/3/2014 8
Panel Presentations
• Summary of the systematic scoping reviews
• Key findings from the secondary data analysis studies
• Policy recommendations deriving from the Health Disparities Project
• Q and A at the end of the session
• Complete project bibliography available as handout or electronically
12/3/2014 9
Panel Members
• Monica McClain, PhD, Research Associate Professor, Institute on Disability (IOD), University of New Hampshire (UNH)
• Amanda Reichard, PhD, Research Assistant Professor, IOD, UNH
• Kimberly Phillips, MA, PhD Candidate, Project Director, IOD, UNH
12/3/2014 10
Systematic Scoping Reviews of the DRRP
Health Disparities Project
Monica R McClain, MS, PhD
12/3/2014
Topics To Be Covered
• Definition of Scoping Review
• Summary of Clinical Preventive Services (CPS) review (Peterson-Besse, J., et al. 2014)
• Summary of Health Outcomes Review (Rowland, M., et al. 2014)
12/3/2014 12
What Is A Scoping Review?
• Scoping reviews are often conducted to examine previous research activity, disseminate findings, identify gaps in the research and/ or determine the
value of conducting a full systematic review
• Rapid gathering of literature in a given policy or clinical area where the aims are to accumulate as much evidence as possible and map the results
12/3/2014 13
(Source: Wilson, et al., 2012; HLWIKI International, 2014)
Scoping Review Process
12/3/2014 14
Review Question
Select Studies
Extraction
Inclusion Criteria
Identify Studies
Mapping the
literature landscape
(analysis/synthesis)
Interpretation
Dissemination
Key question:
What studies have been published in the peer-reviewed literature that examine clinical preventive service (CPS) use disparities among subgroups of people with disabilities ages 18-64?
12/3/2014 15
CPS Scoping Review
• 4,160 abstracts reviewed– 107 full text articles assessed
• 27 articles included for data extraction
• Disability factors: Disabling condition category, Disability severity, Secondary conditions
• Demographic factors: Age, Gender, Race/ethnicity, Language, Marital status, Income or socioeconomic status, Education
• Geography: Urban/rural, U.S. region • Health care system: health insurance payer type, usual source
of care, health care provider type
12/3/2014 16
CPS Scoping Review
12/3/2014 17
3
1
2
1 1 1 1
2
1
2
1 11
3
2 2
1
2
3
2
0
1
2
3
4
5m
amm
ogr
aph
y
clin
ical
bre
ast
exam
cerv
ical
can
cer
scre
enin
g
cho
lest
ero
l tes
tin
g
tob
acco
scr
een
ing
alco
ho
l scr
een
ing
exer
cise
co
un
selin
g
nu
trit
ion
co
un
selin
g
Evidence ofdifference
Mixedevidence
No evidence ofdifference
# o
f st
ud
ies
CPS Scoping Review – Disability Severity
12/3/2014 18
3
2
3
1
2
4
2
0
1
2
3
4
5m
amm
ogr
aph
y
cerv
ical
can
cer
scre
enin
g
cho
lest
ero
l tes
tin
g
pre
ven
tive
den
tal
care
Evidence ofdifference
Mixedevidence
No evidence ofdifference
# o
f st
ud
ies
CPS Scoping Review – Disabling Condition Category
12/3/2014 19
1
2
3
0
1
2
3
4
5
cholesterol testing CPS in general
Evidence ofdifference
Mixedevidence
No evidence ofdifference
# o
f st
ud
ies
CPS Scoping Review - Insurance
12/3/2014 20
1
2
0
1
2
3
4
5
cholesterol testing
Evidence ofdifference
Mixedevidence
No evidence ofdifference
# o
f st
ud
ies
CPS Scoping Review - Age
12/3/2014 21
1
2
0
1
2
3
4
5
CPS in general
Evidence ofdifference
Mixedevidence
No evidence ofdifference
# o
f st
ud
ies
CPS Scoping Review - Ethnicity
Systematic Scoping Review Results
• Many gaps exist in the research on CPS, disability, and determinants
• Variety of research methods & disability definitions
• Directionality of evidence not consistent
12/1/2014 22
Key question:
What studies published in the peer-reviewed literature examine disparities in health, related to the leading causes of death, in the US among subgroups of people with disabilities ages 18-64?
12/3/2014 23
Health Outcomes Scoping Review
• 4,248 abstracts reviewed
–239 full text articles assessed
• 29 articles included for data extraction
• No assessment of directionality of evidence
12/3/2014 24
Health Outcomes Scoping Review
12/3/2014 25
10
7 76
4
0123456789
10d
iab
etes
mel
litu
s
hea
rt d
isea
se
acci
den
ts/i
nju
ries
can
cer
resp
irat
ory
dis
ease
# o
f st
ud
ies
Health Outcomes Scoping Review –Type of Disability
12/3/2014 26
5
3
0123456789
10
accidents/injuries respiratory disease
# o
f st
ud
ies
Health Outcomes Scoping Review –Disability Severity
12/3/2014 27
5 5
0123456789
10
accidents/injuries diabetes mellitus
# o
f st
ud
ies
Health Outcomes Scoping Review -Age
12/3/2014 28
7
4
6
34
0123456789
10d
iab
etes
mel
litu
s
hea
rt d
isea
se
acci
den
ts/i
nju
ries
can
cer
resp
irat
ory
dis
ease
# o
f st
ud
ies
Health Outcomes Scoping Review -Gender
12/3/2014 29
34
0123456789
10
accidents/injuries diabetes mellitus
# o
f st
ud
ies
Health Outcomes Scoping Review –Race/Ethnicity
12/3/2014 30
3
0123456789
10
accidents/injuries
# o
f st
ud
ies
Health Outcomes Scoping Review –Income/Socioeconomic Status & Education
Conclusions
• Many significant gaps in research on health disparities among people with disabilities
• Heterogeneity of populations and factors studied
12/1/2014 31
Recommendations For Future Health Disparities Research
• Rigorous methods
• Clear and consistent definitions
• Identification of individual characteristics associated with suboptimal receipt of CPS and adverse health outcomes
12/1/2014 32
Secondary Data Analysis Studies Methods and
Results
Amanda Reichard, PhD
12/3/2014
Methods
• Pooled data from the Medical Expenditures Panel Survey (MEPS) Nationally-representative sample of US
• Working age, community-dwelling adults
• Descriptives, Chi-square, Logistic regression and Wald tests
12/3/2014 34
Methods
• Pooled data set 1 – (2002-2008)
– Used hearing impairment as referent group
– Excluded “no disability” group
• Pooled data set 2 – (2004-2010)
– More current data
– Used “no disability” as referent group
12/3/2014 35
Methods• Some analyses compared large “all limitations” to
“no limitations” groups
• Classified population into 1 of 6 mutually exclusive groups:
• Cognitive limitations
• Physical limitations
• Hearing impairments
• Visual impairments
• Multiple limitations
• No limitations
12/3/2014 36
Statistical Justification
12/3/2014 37
Statistical testing demonstrated:
• Health outcomes differ sufficiently among the heterogeneous disability population to justify using empirically relevant subgroups in research.
• Further, the results suggest that each of the five disability subpopulations should be examined separately.
Outcomes to be Discussed
• Health Outcomes
– Physical health
– Mental health
– Multiple chronic conditions
• Access to Health Care
• Clinical Preventive Services & Screenings
12/3/2014 38
Health Outcomes
• In comparison to the general population, people with disabilities experience poorer health outcomes related to:– Physical health (self-report)
– Mental health (self-report)
– Chronic conditions, including comorbidity (MCC)
• Disability subgroups experience disparities in these outcomes differentially
12/3/2014 39
12/3/2014 40
10 12
33 31
55
0%
10%
20%
30%
40%
50%
60%
Hearing Vision Physical Cognitive Multiple
Prevalence Reporting Fair or Poor Physical Health
(Source: Horner-Johnson, W., et al., 2013 10; Dobbertin, et al., 2014 11; Reichard et al., 2014 16)
12/3/2014 41
5 611
39
32
0%
10%
20%
30%
40%
50%
60%
Hearing Vision Physical Cognitive Multiple
Prevalence Reporting Fair or Poor Mental Health
(Source: Horner-Johnson, W., et al., 2013)
Multiple Chronic Conditions (MCC)
• Includes:
– Asthma
– Cardiovascular disease
– Chronic Obstructive Pulmonary Disorder (COPD)
– Diabetes
– High blood pressure
– Stroke
12/3/2014 42
12/3/2014 43
11
49
2521 19
61
0
10
20
30
40
50
60
70
NoDisability
Physical Cognitive Visual Hearing Multiple
Prevalence of Multiple Chronic Conditions, by Disability Type
(Source: Reichard, A., et al., 2014 15)
Asthma
• Working-age adults with physical limitations are more likely to have asthma, but no disparities in asthma-related health care quality, utilization, or cost were found
• Working-age adults with physical limitations had more poorly controlled asthma than people without disabilities, suggesting that they likely received suboptimal care, resulting in poor asthma management
12/3/2014 44
(Source: Stransky, M., et al., 2014)
Access To Care• In comparison to the general population,
people with disabilities experience differential access to care related to:– Usual Source of Care (USC)
– Insurance Status
– Delayed/Not Received Care
• Prevalence of these variables also differs among disability subgroups
12/3/2014 45
(Source: Stransky, M., et al., 2014)
Access To Care
• Access to care among disability subgroups is based (in part) on variability in:
– Complexity of health profile and care needs
– Sociodemographics
– Health factors
12/3/2014 46
(Source: Reichard, A., et al., 2014 15; Dobbertin, K., et al., 2014 15)
12/3/2014 47
71
8582
7075
87
50%
60%
70%
80%
90%
100%
Nodisability
Physical Cognitive Visual Hearing Multiple
Prevalence Of Having A Usual Source Of Care, By Disability Type
(Source: Reichard, A., et al., 2014 15)
12/3/2014 48
1816
11
22
1714
0%
10%
20%
30%
40%
50%
Nodisability
Physical Cognitive Visual Hearing Multiple
Prevalence Of Uninsured, By Disability Type
(Source: Reichard, A., et al., 2014 15)
12/3/2014 49
11
29 2927
23
45
0%
10%
20%
30%
40%
50%
Nodisability
Physical Cognitive Visual Hearing Multiple
Prevalence Of Delayed/Not Received Necessary Care
(Source: Reichard, A., et al., 2014 15)
Clinical Preventive Services (CPS)
• Compared to people without disabilities, people with disabilities are less likely to receive recommended clinical preventive services and screenings (CPS)
– Mammogram
– Pap test
– Dental check-up
12/3/2014 50
(Source: Drum, C., et al., 2014; Horner-Johnson, W., et al., 2014 10, 12)
Clinical Preventive Services (CPS)• Disability subgroups have differential receipt of
CPS
• Receipt of CPS differs by sociodemographics and health factors
• Re mammography and Pap test, complexity of limitations matters– Basic limitations
– Complex limitations
– Basic and complex limitations
12/3/2014 51
(Source: Drum, C., et al., 2014; Horner-Johnson, W., et al., 2014 10, 12)
Mammogram In Last Two Years
12/3/2014 52
HP 2020 Target:81%
80
75*77
63* 62*
83
69*
50
60
70
80
90
NoDisability
AnyDisability
Physical Cognitive Visual Hearing Multiple
(Source: Drum, C., et al., 2014)
64
50*53*
45* 48*49*
39*
30
40
50
60
70
NoDisability
AnyDisability
Physical Cognitive Visual Hearing Multiple
Dental Check-Up ≥ 1/Year
12/3/2014 53
HP 2020 Target:49%
(Source: Drum, C., et al., 2014)
Sociodemographic Influence
• Impact and association of sociodemographic and systems-level variables on individuals’ likelihood of receiving CPS
– Age, race/ethnicity, marital status, residence in MSA, region, education, income
– Health insurance, usual source of care
• Degree of disparity changes depending on which factors are included in statistical models
12/3/2014 54
Policy ImplicationsKimberly
Phillips, MA,
PhD Candidate
12/3/2014
Disability-Related Health Disparities
• People with disabilities can enjoy good health
• Experience disparities in health related to
– Access (physical, financial)
– Receipt of care
– Quality of care
– Outcomes
12/3/2014 56
Surveillance and Monitoring
• Type of disability
• Standardized definitions of disability and severity
• Severity of disability or complexity of limitations
• Age of onset or acquisition
12/3/2014 57
Disability Subgroups
• Infusion approach to programs & policies?
• Separate programs & policies costly
• Obligation to include people with disabilities to the greatest extent possible
• Use knowledge of unique needs & circumstances to ensure universal accessibility
12/3/2014 58
Before And After The ACA
• Usual source of care & health insurance are important
• ACA suggests > access to affordable health insurance & ability to afford needed care
• Impact studies will need state-
level information to assess
change over time
12/3/2014 59
Provider Training Programs
• ACA calls for training for health care providers– Culturally appropriate
– Respectful
– Overcome communication barriers
• Logistical issues– Accessible medical equipment
– Transfers
– Accessible facilities
12/3/2014 60
Public Education Programs
• Health education
campaigns
• Education about
changes to law and
new health policies
12/3/2014 61
Creative Partnerships
• Education & training across disparity areas
• Creative partnerships leverage each others to strengthen messages
• National Partnership for Action
to End Health Disparities:
Regional Health Equity
Councils
12/3/2014 62
Question And Answers
12/3/2014 63
Non-Project References
• Wilson, et al., Health Research Policy and Systems, 2012; 10:36
• HLWIKI International. (n.d.). Retrieved November 24, 2014, from http://hlwiki.slais.ubc.ca/index.php/HLWIKI_International
12/3/2014 65
