A Longitudinal Evaluation of Persons With Disabilities: Does a Longitudinal Definition Help Define Who Receives Necessary Care?
Abstract
Chan L, Ciol MA, Shumway-Cook A, Yorkston KM, Dudgeon BJ, Asch SM, Hoffman JM. A longitudinal evaluation of persons with disabilities: does a longitudinal definition help define who receives necessary care?
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.
Participants
Participants (N=29,074) of the Medicare Current Beneficiary Survey (1992–2001) with no, increasing, decreasing, and stable ADL disability.
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 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.
aRehabilitation Medicine Department, Clinical Research Center, National Institutes of Health, Bethesda, MD
bUniversity of Washington School of Medicine, Seattle, WA
cHealth Services Research and Development Service, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA.
Reprint requests to Leighton Chan, MD, MPH, Rehabilitation Medicine Dept, National Institutes of Health, Bldg 10, CRC, Room 1-1469, 10 Center Dr, MSC 1604, Bethesda, MD 20892-1604
Supported by the Centers for Disease Control and Prevention (grant no. MM-0625-04/04); the Intramural Research Program, National Institutes of Health (Clinical Research Center); and the Centers for Medicare and Medicaid Services.
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.
ABSTRACT