Stephen P Gulley1, Elizabeth K Rasch, Leighton Chan. 1. National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Building 10, CRC, Room 1-1469, 10 Center Dr., MSC-1604, Bethesda, MD 20892-1604, USA. gulley@brandeis.edu
Abstract
OBJECTIVES: A critical issue in health-care reform concerns how to realign health-care delivery systems to manage medical care services for people with ongoing and costly needs for care. We examined the overlapping health-care needs of two such population groups among the U.S. working-age population (those aged 18-64 years): people with chronic medical conditions and people with disabilities. METHODS: Using the Medical Expenditure Panel Survey (2002-2004), we examined differences in health status, service use, and access to care among and between working-age adults reporting disabilities and/or one or more chronic conditions. We also analyzed people with three key chronic conditions: arthritis, diabetes, and depression. RESULTS: More than half of working-age people with disabilities reported having more than one chronic condition. Among those with activities of daily living or instrumental activities of daily living limitations, 35% reported four or more chronic conditions at a time. We found considerable variability in access problems and service use depending on how we accounted for the overlap of multiple conditions among people with arthritis, diabetes, and depression. However, disability consistently predicted higher emergency department use, higher hospitalization rates, and greater access problems. CONCLUSIONS: The overall prevalence of chronic conditions among the U.S. working-age population, coupled with the high concentration of multiple chronic conditions among those with disabilities, underscores the importance of reforming health-care delivery systems to provide person-centered care over time. New policy-relevant measures that transcend diagnosis are required to track the ongoing needs for health services that these populations present.
OBJECTIVES: A critical issue in health-care reform concerns how to realign health-care delivery systems to manage medical care services for people with ongoing and costly needs for care. We examined the overlapping health-care needs of two such population groups among the U.S. working-age population (those aged 18-64 years): people with chronic medical conditions and people with disabilities. METHODS: Using the Medical Expenditure Panel Survey (2002-2004), we examined differences in health status, service use, and access to care among and between working-age adults reporting disabilities and/or one or more chronic conditions. We also analyzed people with three key chronic conditions: arthritis, diabetes, and depression. RESULTS: More than half of working-age people with disabilities reported having more than one chronic condition. Among those with activities of daily living or instrumental activities of daily living limitations, 35% reported four or more chronic conditions at a time. We found considerable variability in access problems and service use depending on how we accounted for the overlap of multiple conditions among people with arthritis, diabetes, and depression. However, disability consistently predicted higher emergency department use, higher hospitalization rates, and greater access problems. CONCLUSIONS: The overall prevalence of chronic conditions among the U.S. working-age population, coupled with the high concentration of multiple chronic conditions among those with disabilities, underscores the importance of reforming health-care delivery systems to provide person-centered care over time. New policy-relevant measures that transcend diagnosis are required to track the ongoing needs for health services that these populations present.
Authors: Amitabh Jha; Donald L Patrick; Richard F MacLehose; Jason N Doctor; Leighton Chan Journal: Arch Phys Med Rehabil Date: 2002-10 Impact factor: 3.966
Authors: Leighton Chan; Shelli Beaver; Richard F Maclehose; Amitabh Jha; Matthew Maciejewski; Jason N Doctor Journal: Arch Phys Med Rehabil Date: 2002-09 Impact factor: 3.966
Authors: Sophia Miryam Schüssler-Fiorenza Rose; Margaret G Stineman; Qiang Pan; Hillary Bogner; Jibby E Kurichi; Joel E Streim; Dawei Xie Journal: Health Serv Res Date: 2016-03-17 Impact factor: 3.402
Authors: Ling Na; Sean Hennessy; Hillary R Bogner; Jibby E Kurichi; Margaret Stineman; Joel E Streim; Pui L Kwong; Dawei Xie; Liliana E Pezzin Journal: Disabil Health J Date: 2016-10-04 Impact factor: 2.554
Authors: Stephen P Gulley; Elizabeth K Rasch; Christina D Bethell; Adam C Carle; Benjamin G Druss; Amy J Houtrow; Amanda Reichard; Leighton Chan Journal: Disabil Health J Date: 2018-01-10 Impact factor: 2.554