Ableism at the Bedside: People with Intellectual Disabilities and COVID-19

Chicoine, Caitlin; Hickey, Erin E; Kirschner, Kristi L.; Chicoine, Brian

doi:10.3122/jabfm.2022.02.210371

Cited by 16 publications

(8 citation statements)

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“…Ableism often manifests as disability bias-the belief that the life of a person with disabilities is less valuable than the lives of those without disability. 18 Ableism is a system of beliefs and practices that frame disability as inherently negative and thus, qualitatively, a diminished way of being. 19 When challenged with facts about racism or ableism in healthcare, doctors and other providers often are quick to say, "not me!"…”

Section: Heath Equity and The Orthopaedic Surgeonmentioning

confidence: 99%

Health Equity for Children with Disabilities

Houtrow¹,

Sabatini²,

Jarvis³

2023

Journal of the Pediatric Orthopaedic Society of North America

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Like all children, children with disabilities deserve the fair and just opportunity to be as healthy as possible. There are many barriers to optimal health for children with disabilities. Eliminating health disparities requires removing or minimizing the obstacles that keep children from being healthy. Because pediatric orthopaedic surgeons are often engaged in the clinical management of children with temporary or permanent disabilities, they are uniquely suited to advocate for inclusive orthopaedic care for all children regardless of their circumstances. Pediatric orthopaedic surgeons can promote health equity for children with disabilities by recognizing how ableist beliefs and actions negatively impact the clinical care of children with disabilities and can take action by addressing biases in their clinical practices and beyond. Key Concepts• Children with disabilities face discrimination in healthcare which put them at risk for worsening health disparities.• Health equity for children with disabilities is defined as the "fair and just opportunity to be as healthy as possible and thrive throughout their lives (e.g., from school to the workforce), without discrimination, and regardless of the circumstances in which they were born or live," according to the Maternal and Child Health Bureau's Blueprint for Change.• Orthopaedic surgeons can promote health equity in their practices by fostering an inclusive clinical environment, employing sensitivity in communication, checking and addressing personal biases, seeking practice-level changes, and engaging with the disability community to better understand their lived expertise.

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Section: Heath Equity and The Orthopaedic Surgeonmentioning

confidence: 99%

Health Equity for Children with Disabilities

Houtrow¹,

Sabatini²,

Jarvis³

2023

Journal of the Pediatric Orthopaedic Society of North America

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“…Individuals with intellectual and developmental disabilities (IDD), including Down syndrome (DS) are one cohort at particular risk for mortality during the COVID‐19 era (Chicoine et al, 2022; Clift et al, 2021; Gleason et al, 2021; Hüls et al, 2021; Malle et al, 2021). With retrospective data showing that patients with DS have more severe disease than controls (Malle et al, 2021), and a 4‐fold increased risk for COVID‐19‐related hospitalization and a 10‐fold increased risk for COVID‐19‐related death in persons with DS (Clift et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…In the COVID‐19 era, clinicians and disability advocates raised concerns that bias, diagnostic overshadowing, and ableism could impact the allocation of code status for patients with DS with theoretical effects on treatment options and overall health outcomes (Chicoine et al, 2022; Moore et al, 2022). Yet this was not previously studied, and we began this study to study mortality and code status for individuals with DS through retrospective review of the Vizient® Clinical Data Bases (Vizient Inc, 2023a) which our research team previously used to demonstrate a shift in care experienced by patients with DS during the COVID‐19 era (Gleason et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Retrospective review of the code status of individuals with Down syndrome during the COVID‐19 era

Jett,

Fossi,

Blonsky

et al. 2023

American J of Med Genetics Pt C

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Code status is a label in the medical record indicating a patient's wishes for end‐of‐life (EOL) care in the event of a cardiopulmonary arrest. People with intellectual disabilities had a higher risk of both diagnosis and mortality from coronavirus infections (COVID‐19) than the general population. Clinicians and disability advocates raised concerns that bias, diagnostic overshadowing, and ableism could impact the allocation of code status and treatment options, for patients with intellectual disabilities, including Down syndrome (DS). To study this, retrospective claims data from the Vizient® Clinical Data Base (used with permission of Vizient, all rights reserved.) of inpatient encounters with pneumonia (PNA) and/or COVID‐19 at 825 hospitals from January 2019 to June 2022 were included. Claims data was analyzed for risk of mortality and risk of “Do Not Resuscitate” (DNR) status upon admission, considering patient age, admission source, Elixhauser comorbidities (excluding behavioral health), and DS. Logistic regression models with backward selection were created. In total, 1,739,549 inpatient encounters with diagnoses of COVID‐19, PNA, or both were included. After controlling for other risk factors, a person with a diagnosis of DS and a diagnosis of COVID‐19 PNA had 6.321 odds ratio of having a DNR status ordered at admission to the hospital compared with those with COVID‐19 PNA without DS. The diagnosis of DS had the strongest association with DNR status after controlling for other risk factors. Open and honest discussions among healthcare professionals to foster equitable approaches to EOL care and code status are needed.

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“…The people living with disabilities are more likely to have underlying health problems [ 9 , 10 ], which have been shown to increase the risk of COVID-19 infections [ 11 , 12 ]. In particular, individuals with intellectual disabilities have a higher risk of mortality from COVID-19 than the general population, even after controlling for comorbidities [ 13 ]. Having an intellectual disability is the strongest independent risk factor other than age for COVID-19 mortality [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Social, Economic and Overall Health Impacts of COVID-19 on People Living with Disabilities in King County, WA

Turcheti

Laurent

Delgado

et al. 2022

IJERPH

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The COVID-19 pandemic and the associated mitigation measures to reduce the spread of disease affected the social, economic, and overall health of individuals. Quantitative administrative datasets typically did not contain demographic information that allowed for reporting or analysis of the impacts of COVID-19 on people living with disabilities. Understanding the experiences of this population during the pandemic can inform the design of public health responses that are more robust and better connected to community. This paper describes a qualitative participatory study with a diverse sample of people living with disabilities in King County, WA. Through 2 listening sessions and 35 semi-structured interviews, it examines what impacts COVID-19 brought for people living with disabilities; elucidates the supports that were helpful in addressing COVID-19 impacts; examines inequities faced by the disability community; and sheds light on how to engage with this community to inform the public health emergency response. The process, protocols, findings, and lessons learned are replicable by other local health departments and could be incorporated as part of routine data collection and considered for future public health emergencies.

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Ableism at the Bedside: People with Intellectual Disabilities and COVID-19

Cited by 16 publications

References 0 publications

Health Equity for Children with Disabilities

Health Equity for Children with Disabilities

Retrospective review of the code status of individuals with Down syndrome during the COVID‐19 era

Social, Economic and Overall Health Impacts of COVID-19 on People Living with Disabilities in King County, WA

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