Attending to Inclusion: People With Disabilities and Health-Care Reform

Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
PM&R (Impact Factor: 1.66). 10/2009; 1(10):957-63. DOI: 10.1016/j.pmrj.2009.09.001
Source: PubMed
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    ABSTRACT: OBJECTIVE: To examine how health-related, socioeconomic, and environmental factors combine to influence onset of Activity of Daily Living (ADL) limitations or prognosis for death, or further functional deterioration or improvement among elderly people. DESIGN: A national representative sample with 2 year follow-up. SETTING: Community-dwelling people. PARTICIPANTS: Included were 9,447 persons (≥70 years old) in the US from the Second Longitudinal Study of Aging interviewed in 1994, 1995, or 1996. METHODS: Self- or proxy-reported health conditions, ADLs expressed as 5 stages describing severity and pattern of limitations, and other baseline characteristics were obtained. A multinomial logistic regression model was used to predict stage transitions. Because of incomplete follow-up (17.7% of baseline sample), primary analyses were based on multiple imputation to address potential bias associated with loss to follow-up. MAIN OUTCOME MEASUREMENT: ADL stage transitions in 2 years (death, deteriorated, stable, and improved ADL function). RESULTS: In the imputed-case analysis, percentages for those who died, deteriorated, were stable, and improved were 12.6%, 32.7%, 48.4%, and 6.2%, respectively. Those at a mild stage of ADL limitation were most likely to deteriorate further. Those at advanced stages were most likely to die. Married people and high school graduates had lower likelihood of deterioration. The risk of mortality and functional deterioration increased with age. Certain conditions, such as diabetes, were associated both with mortality and functional deterioration, others such as cancer with mortality only, and arthritis only with functional deterioration. CONCLUSIONS: Although there is overlap, different clinical traits are associated with mortality, functional deterioration, and functional improvement. ADL stages might aid Physical Medicine and Rehabilitation clinicians and researchers in developing and monitoring disability management strategies targeted to maintaining and enhancing self-care among community-dwelling older people.
    PM&R 02/2013; DOI:10.1016/j.pmrj.2013.02.008 · 1.66 Impact Factor
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    ABSTRACT: OBJECTIVE: To examine the relationship between emergency department (ED) use and access to medical care and prescription medications among working age Americans with disabilities. DATA SOURCE: Pooled data from the 2006-2008 Medical Expenditure Panel Survey (MEPS), a U.S. health survey representative of community-dwelling civilians. STUDY DESIGN: We compared the health and service utilization of two groups of people with disabilities to a contrast group without disability. We modeled ED visits on the basis of disability status, measures of health and health conditions, access to care, and sociodemographics. DATA EXTRACTION: These variables were aggregated from the household component, the medical condition, and event files to provide average annual estimates for the period spanning 2006-2008. PRINCIPAL FINDINGS: People with disabilities accounted for almost 40 percent of the annual visits made to U.S. EDs each year. Three key factors affect their ED use: access to regular medical care (including prescription medications), disability status, and the complexity of individuals' health profiles. CONCLUSIONS: Given the volume of health conditions among people with disabilities, the ED will always play a role in their care. However, some ED visits could potentially be avoided if ongoing care were optimized.
    Health Services Research 12/2012; 48(4). DOI:10.1111/1475-6773.12025 · 2.49 Impact Factor
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    ABSTRACT: As curricula to improve medical students' attitudes toward people with disabilities are developed, instruments are needed to guide the process and evaluate effectiveness. The authors developed an instrument to measure medical students' attitudes toward people with disabilities. A pilot instrument with 30 items in four sections was administered to 342 medical students. Internal consistency reliability and factor analysis were conducted. The Cronbach's alpha coefficient was 0.857, indicating very good internal consistency. Five components were identified: comfort interacting with people with disabilities, working with people with disabilities in a clinical setting, negative impressions of self-concepts of people with disabilities, positive impressions of self-concepts of people with disabilities, and conditional comfort with people with disabilities. The instrument appears to have good psychometric properties and requires further validation.
    Intellectual and Developmental Disabilities 06/2012; 50(3):251-60. DOI:10.1352/1934-9556-50.3.251 · 1.13 Impact Factor