Research contributions and implications

Reichard, Amanda; Nary, Dorothy E.; Simpson, Jamie Lloyd

doi:10.1016/j.dhjo.2013.09.005

Cited by 12 publications

(10 citation statements)

References 34 publications

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“…Beyond what has been documented in recent studies 25,26,33-36 , much still remains to be learned about the interrelationships between chronic conditions, disability and high use/cost populations. Chronic health conditions are highly prevalent among the working age, frequently occur two or more at a time, and result in highly variable service use patterns and health status.…”

Section: Resultsmentioning

confidence: 94%

Diagnosis isn't enough: Understanding the connections between high health care utilization, chronic conditions and disabilities among U.S. working age adults

Reichard

Gulley

Rasch

et al. 2015

Disability and Health Journal

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Background Under the ACA, new programs are being developed to enhance care coordination and reduce healthcare costs among people with chronic conditions, disabilities, and high utilization of healthcare. However, the relationships between these groups are not well understood. Objectives Our aims were to (1) identify high utilizers of healthcare 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 healthcare 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 healthcare 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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Section: Resultsmentioning

confidence: 94%

Diagnosis isn't enough: Understanding the connections between high health care utilization, chronic conditions and disabilities among U.S. working age adults

Reichard

Gulley

Rasch

et al. 2015

Disability and Health Journal

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“…Most studies exploring differences in health care expenditures focus either on disability, either on chronic conditions [ 44 ]. However, the conceptual framework of disability currently preferred by most experts is one in which disability is related to, but separate from chronic conditions [ 21 ]. There are several reasons for this.…”

Section: Discussionmentioning

confidence: 99%

“…Disability is often related with the presence of chronic conditions, which include essentially physical and mental diseases, and also risk factors such as hypertension and hyperlipidaemia are chronic conditions [ 20 ]. Although the terms “chronic conditions” and “disability” are sometimes mixed up, current views prefer to consider them as related, but separate concepts [ 21 ]. People with chronic conditions may experience some form of disability, but not every person with a disability experiences a chronic health problem.…”

Section: Introductionmentioning

confidence: 99%

Activity limitations predict health care expenditures in the general population in Belgium

et al. 2015

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BackgroundDisability and chronic conditions both have an impact on health expenditures and although they are conceptually related, they present different dimensions of ill-health. Recent concepts of disability combine a biological understanding of impairment with the social dimension of activity limitation and resulted in the development of the Global Activity Limitation Indicator (GALI). This paper reports on the predictive value of the GALI on health care expenditures in relation to the presence of chronic conditions.MethodsData from the Belgian Health Interview Survey 2008 were linked with data from the compulsory national health insurance (n = 7,286). The effect of activity limitation on health care expenditures was assessed via cost ratios from multivariate linear regression models. To study the factors contributing to the difference in health expenditure between persons with and without activity limitations, the Blinder-Oaxaca decomposition method was used.ResultsActivity limitations are a strong determinant of health care expenditures. People with severe activity limitations (5.1%) accounted for 16.9% of the total health expenditure, whereas those without activity limitations (79.0%), were responsible for 51.5% of the total health expenditure. These observed differences in health care expenditures can to some extent be explained by chronic conditions, but activity limitations also contribute substantially to higher health care expenditures in the absence of chronic conditions (cost ratio 2.46; 95% CI 1.74-3.48 for moderate and 4.45; 95% CI 2.47-8.02 for severe activity limitations). The association between activity limitation and health care expenditures is stronger for reimbursed health care costs than for out-of-pocket payments.ConclusionIn the absence of chronic conditions, activity limitations appear to be an important determinant of health care expenditures. To make projections on health care expenditures, routine data on activity limitations are essential and complementary to data on chronic conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1607-7) contains supplementary material, which is available to authorized users.

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“…This means engaged collaboration between disability programs and chronic disease programs as exemplified by Seekins in this issue, 31 and improved disability-relevant epidemiologic research as Reichard discusses in this issue. 32 We present these considerations and initial conceptual model as an invitation to continued dialog among chronic disease and disability stakeholders to develop a conceptual framework and approach for preventing and managing chronic diseases and conditions that includes people with pre-existing disabilities.…”

Section: Conclusion and Invitation To Dialoguementioning

confidence: 99%

Toward a conceptual model for national policy and practice considerations

Krahn

Reyes

Fox

2014

Disability and Health Journal

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Chronic diseases and conditions are serious threats to the population’s health. Chronic diseases represent seven of the top ten causes of mortality in the U.S. and are major economic drivers underlying burgeoning national health costs. People with disabilities experience dramatically higher rates of some chronic conditions, but only recently has this problem been recognized. We propose a set of contributing factors and a model to help better understand the relationship of disability with chronic disease. The paper summarizes current CDC initiatives to include disability status and considerations in public health surveys and programs, exemplifying a strategy to promote inclusion of people with disabilities in mainstream programs wherever possible; use cross-disability strategies for conditions unique to people with disabilities where necessary; and implement condition-specific approaches where essential. This initial model is intended to invite dialog on a conceptual framework for preventing chronic conditions and additional functional limitations among people with disabilities.

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Research contributions and implications

Cited by 12 publications

References 34 publications

Diagnosis isn't enough: Understanding the connections between high health care utilization, chronic conditions and disabilities among U.S. working age adults

Diagnosis isn't enough: Understanding the connections between high health care utilization, chronic conditions and disabilities among U.S. working age adults

Activity limitations predict health care expenditures in the general population in Belgium

Toward a conceptual model for national policy and practice considerations

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