Disability and health care costs in the Medicare population

Chan, Leighton; Beaver, Shelli K.; MacLehose, Richard F.; Jha, Abhay K.; Maciejewski, Matthew L.; Doctor, Jason N.

doi:10.1053/apmr.2002.34811

Cited by 104 publications

(93 citation statements)

References 11 publications

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“…Guralnik and colleagues 39 found a substantial increase in the cost of health care for community-based Medicare beneficiaries transitioning from independence with ADL tasks to requiring help with one or more ADL tasks. Chan et al 40 also found that total median health care costs for Medicare beneficiaries increased as ADL limitations increased and were due to an increase in the frequency of health care events (ie, inpatient, outpatient, or home Although managed care is often considered a barrier to health care access, subjects who participated in a managed care plan were 17% more likely to use physical therapy than subjects who did not participate in a managed care plan. Subjects who participated in managed care plans, however, incurred lower physical therapy costs than subjects who did not participate in managed care plans.…”

Section: Discussionmentioning

confidence: 98%

Physical Therapy Use by Community-Based Older People

Freburger

Holmes²

2005

Physical Therapy

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Background and Purpose. Little information is available on factors associated with physical therapy use. Identifying the characteristics of people who use physical therapy and some of the factors associated with its use is a useful first step in determining whether disparities exist in physical therapy use. The purpose of this study was to identify factors associated with physical therapy use by community-based older people. Subjects. The subjects were community-based people 65 years of age or older who participated in the Medicare Current Beneficiary Survey and had at least one physician encounter (Nϭ38,312 person-years across 20,227 individuals). Methods. Logit and ordinary least squares regression analyses were conducted to identify factors associated with physical therapy use. Results. Several measures of health and function were associated with physical therapy use. Several demographic, insurance, and geographic characteristics also were associated with physical therapy use. Income, education, having supplemental private insurance, participating in a managed care plan, and physical therapist supply were positively associated with physical therapy use. Age was negatively associated with physical therapy use. For people who saw a physical therapist, amount of physical therapy received was positively associated with income, having supplemental private insurance, living in a metropolitan area, physical therapist supply, and being African American. Amount of physical therapy received was negatively associated with being in a managed care plan. Discussion and Conclusions. Variation in physical therapy use, explained by factors other than need, suggests potential underuse or overuse of physical therapy by community-based older people. [Freburger JK, Holmes GM. Physical therapy use by community-based older people. Phys Ther. 2005;85:19 -33.]

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Section: Discussionmentioning

confidence: 98%

Physical Therapy Use by Community-Based Older People

Freburger

Holmes²

2005

Physical Therapy

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“…Care for older adults with disabilities also requires significant healthcare expenditures (Chan et al, 2002;Fried, Bradley, Williams, & Tinetti, 2001). Therefore, it is important to investigate factors that may influence the functional ability of older adults so that gerontologists can understand the disablement process in the elderly.…”

Section: Studies Have Shown That Older Adults With Disabilities In Admentioning

confidence: 99%

Disability trajectories and associated disablement process factors among older adults in Taiwan

Chen

Chiang

et al. 2015

Archives of Gerontology and Geriatrics

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“…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 satisfaction in a number of domains of the care provided, including ease of getting to the doctor, cost of care, and availability of specialists. In addition, the risk for these adverse outcomes appears to grow with increasing levels of disability even after adjusting for other factors such as age, sex, race, and socioeconomic factors.…”

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confidence: 99%

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

Chan

Ciol

Shumway-Cook

et al. 2008

Archives of Physical Medicine and Rehabilitation

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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...

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Disability and health care costs in the Medicare population

Cited by 104 publications

References 11 publications

Physical Therapy Use by Community-Based Older People

Physical Therapy Use by Community-Based Older People

Disability trajectories and associated disablement process factors among older adults in Taiwan

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

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