A Longitudinal Evaluation of Persons With Disabilities: Does a Longitudinal Definition Help Define Who Receives Necessary Care?

Abstract

Objective-To assess, using a longitudinal definition, the impact of disability on a broad range of objective health care quality indicators.Design-Longitudinal cohort study following up with patients over several years. The first 2 interviews, 1 year apart, were used to determine each patient's disability status in activities of daily living (ADLs). Assessment of the health care indicators commenced after the second interview and continued throughout the survey period (an additional 1-3y).Setting-National survey. (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) with no, increasing, decreasing, and stable ADL disability. Participants-Participants (N[H11005]29,074) of the Medicare Current Beneficiary Survey Interventions-Not applicable.Main Outcome Measure-The incidence of 5 avoidable outcomes, receipt of 3 preventive care measures, and adherence to 32 diagnostically based indicators assessing the quality of treatment for acute myocardial infarction [AMI], angina, breast cancer, cerebrovascular accident, transient ischemic attack, cholelithiasis, chronic obstructive pulmonary disease [COPD], congestive heart failure, depression, gastrointestinal bleeding, diabetes, and hypertension.Results-For most indicators, less than 75% of eligible patients received necessary care, regardless of disability status. For 5 indicators, less than 50% of patients received appropriate treatment. In a logistic regression analysis that controlled for patient age, sex, race, and income, disability status was a significant factor in 7 quality measures (AMI, breast cancer, COPD, diabetes, angina, pneumonia, annual visits).Conclusions-Using a longitudinal definition of disability and objective health quality indicators, we found that disability status can be an important factor in determining receipt of quality health care in a broad range of diagnostic categories. However, the impact of disability -1469, 10 Center Dr, MSC 1604, Bethesda, MD 20892-1604 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript status varies depending on the indicator measured. In this cohort of patients, the changing nature of a person's disability seems to have less impact than whether they ever have had any functional deficits. KeywordsDisability evaluation; Medicare; Rehabilitation Disability has been shown to be a risk factor for a variety of poor outcomes in health care. These adverse outcomes have been documented in several populations experiencing a wide variety of limitations including mobility limitation, communication limitation, as well as physical, sensory, and psychiatric disability. [1][2][3][4][5] In these studies, subjects with disabilities were at risk for receipt of fewer preventive measures, such as mammograms and Papanicolaou (Pap) smears, as well as decreased satisf...

Is there empirical evidence for “Defensive Medicine”? A reassessment

“…For AMI, payments decline with age and with the mean number of ADL limitations; the results for age are consistent with past research on the relationship between age and aggressiveness of care following AMI (Spencer et al, 2001). The result for ADL limitations further suggests that persons with co-existing conditions and disabilities are less likely to receive aggressive and costly care, results consistent with more general findings that persons with disabilities are less likely to receive necessary care (Chan et al, 2008). There are clearly some important differences in determinants of Medicare spending among the four diseases which serves to emphasize that treatment patterns differ by admitting condition (Sloan et al, 2004).…”

Patient Satisfaction and Perceived Quality of Care Among Older Adults According to Activity Limitation Stages

“…Sociodemographic characteristics included age (65-74, 75-84, and 85 and over 24 ); gender; race/ethnicity (non-Hispanic African American or Black, Hispanic, non-Hispanic White, and other 25 ); education (high school diploma or greater/less than high school diploma 26 ); income (≤$25,000/>$25,000 27 ); supplemental insurance type (Medicare only, Medicare and Medicaid-dual enrollee, private-supplemental, other (i.e., Champus, VA)); living arrangement (lives alone, with spouse, with children, with other relatives or non-relatives, or in a retirement community); and the presence or absence of accessibility features in the home. Health status was captured by self-reported chronic conditions and impairments.…”

Disability and Incident Coronary Heart Disease in Older Community‐Dwelling Adults: The Three‐City Study

“…A more recent study suggested that disability status was strongly associated with receipt of quality health care in a broad range of diagnostic categories. 19 Unfortunately, the current study did not collect information on the severity of CHD or on in-hospital treatment. Third, disability could be a prognosis factor per se by limiting the ability of disabled subjects to cope when an acute event occurs, making them more likely to die.…”