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Amanda Reichard Michelle Stransky Kimberly Phillips Monica McClain Charles Drum 《Disability and health journal》2017,10(1):39-47
Background
While it is commonly accepted that disparities in unmet need for care vary by age, race/ethnicity, income, education, and access to care, literature documenting unmet needs experienced by adults with different types of disabilities is developing.Objective
The main objective was to determine whether subgroups of people with disabilities are more likely than people without disabilities to delay/forgo necessary care, in general and among the insured.Methods
We used pooled Medical Expenditure Panel Survey data (2004–2010) to examine delaying or forgoing medical, dental, and pharmacy care among five disability subgroups (physical, cognitive, visual, hearing, multiple) and the non-disabled population. Logistic regression was conducted to examine delayed/forgone care, controlling for sociodemographic, health, and health care factors.Results
Over 13% of all working-age adults delayed/forwent necessary care; lack of insurance was the strongest predictor of unmet needs. Among the insured, disability subgroups were greater than two times more likely to report delayed/forgone care than adults without disabilities. Insured working-age adults with multiple chronic conditions and those with ADL/IADL assistance needs had higher odds of delayed or forgone care than their peers without these characteristics. Reasons related to affordability were most often listed as leading to unmet needs, regardless of disability.Conclusion
Although insurance status most strongly predicted unmet needs for care, many people with insurance delayed/forewent necessary care. Even among the insured, all disability subgroups had significantly greater likelihood of having to delay/forgo care than those without disabilities. Differences also existed between the disability subgroups. Cost was most frequently cited reason for unmet needs. 相似文献3.
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Background
Experiences of discrimination lead people from vulnerable groups to avoid medical healthcare. It is yet to be known if such experiences affect people with disabilities (PWD) in the same manner.Objectives
To determine the association between perceived discrimination and healthcare-seeking behavior in people with disabilities and to explore differences of this association across disability types.Methods
We performed a cross-sectional study with data from a national survey of people with disabilities. Perceived discrimination and care-seeking behavior were measured as self-reports from the survey. Dependence for daily life activities, possession of health insurance, and other disability-related variables were included and considered as confounders. We used Poisson regression models and techniques for multistage sampling in the analyses. A stratified analysis was used to explore effects of discrimination across types of disability.Results
Most of PWD were 65 years or older (67.1%). Prevalence of healthcare seeking was 78.8% in those who perceived discrimination, and 86.1% in those who did not. After adjusting for potential confounders, the probability of not seeking care was higher in people who reported perceived discrimination (adjusted PR = 1.15; 95%CI: 1.04–1.28). In a stratified analysis, significant effects of discrimination were found in people with communication disability (adjusted PR = 1.34, 95%CI: 1.07–1.67) and with physical disability (adjusted PR = 1.17, 95%CI: 1.03–1.34).Conclusions
People with disabilities who perceive discrimination are less likely to seek healthcare. This association was higher for people with communication and physical disabilities. These results provide evidence to institutions who attempt to tackle discrimination. 相似文献7.
Ling Na Sean Hennessy Hillary R. Bogner Jibby E. Kurichi Margaret Stineman Joel E. Streim Pui L. Kwong Dawei Xie Liliana E. Pezzin 《Disability and health journal》2017,10(1):48-57
Background
Receipt of recommended care among older adults is generally low. Findings regarding service use among persons with disabilities supports the notion of disparities but provides inconsistent evidence of underuse of recommended care.Objective
To examine the extent to which receipt of recommended care among older Medicare beneficiaries varies by disability status, using a newly developed staging method to classify individuals according to disability.Methods
In a cohort study, we included community-dwelling Medicare beneficiaries aged 65 and older who participated in the Medicare Current Beneficiary Survey between 2001 and 2008. Logistic regression modeling assessed the association of receiving recommended care on 38 indicators across different activity limitation stages.Results
Nearly one out of every three elderly Medicare beneficiaries did not receive overall recommended care. Adjusted odds ratios (ORs) revealed a decrease in use of recommended care with increasing activity limitation stage. For instance, ORs (95% CIs) across mild, moderate, severe and complete limitation stages (stages I–IV) compared to no limitation (stage 0) in ADLs were 0.99 (0.94–1.05), 0.89 (0.83–0.95), 0.81 (0.75–0.89) and 0.56 (0.46–0.68). Disparities in receipt of recommended care by disability stage were most marked for care related to post-hospitalization follow-up and, to a lesser degree, care of chronic conditions and preventive care.Conclusions
Elderly beneficiaries at higher activity limitation stages experienced substantial disparities in receipt of recommended care. Tailored interventions may be needed to reduce disparities in receipt of recommended medical care in this population. 相似文献8.
Catherine Ipsen Cathy Chambless Noelle Kurth Sara McCormick Rebecca Goe Jean Hall 《Disability and health journal》2018,11(3):447-450
Background
Disability prevalence estimates are used to identify populations, establish priorities and allocate funding for a broad range of federal, state, and local initiatives. Increasingly, these estimates are based on a set of six questions developed and tested for use in the American Community Survey (ACS). A key assumption about the ACS disability screeners is that they sufficiently capture the entire population of people with disabilities, but some studies indicate that certain disability groups are underrepresented.Objectives
The objective of this study is to explore potential underrepresentation of certain disability groups identified by the ACS disability questions.Methods
We compared disability prevalence rates from two data sources for adolescents with disabilities, aged 14 to 16, who receive Supplemental Security Income (SSI, n = 2051). The Social Security Administration (SSA) provided disability determination data for each adolescent, and adolescents (or proxy-rater) provided baseline self-report data about functional limitation based on the six ACS disability questions.Results
Approximately 17% of the sample did not endorse any ACS questions. Excluding SSA categories with cell counts less than 10, the top five conditions not captured by ACS questions included respiratory conditions (38%), mood disorders (28%), other mental disorders (27%), schizophrenic and other psychotic disorders (27%) and developmental disorders (20%).Conclusions
Our findings suggest that people with mental health and developmental disabilities and those with respiratory conditions are among those groups under-represented by the ACS disability questions. Changes or additions to ACS questions should be considered to ensure that all disability groups are addressed in public health planning. 相似文献9.
Lisa I. Iezzoni Dennis Heaphy Kimberley S. Warsett Sarah A. Marsella 《Disability and health journal》2018,11(4):545-554
Background
Persons leading their own evaluations of care quality offers the promise of generating maximally meaningful information to ensure person-centered care.Objectives
To describe an intervention where persons with disability engage other persons with disability, develop their own metrics to assess their care, and provide these care evaluations directly to primary care practitioners, with the goal of improving care. The context was a research study involving One Care, a Massachusetts demonstration program with capitated reimbursement for individuals ages 18–64 dually eligible for Medicare and Medicaid.Methods
Individuals with serious mental illness or significant physical disability designed and implemented “YESHealth: Your Experience, Speak up for better health care.” To solicit and communicate with YESHealth members, they mailed postcards announcing YESHealth to potential participants, created a website, sponsored a Facebook group, and staffed telephones in English and Spanish. YESHealth also involved reaching out to numerous disability advocacy organizations, developing and conducting short quarterly surveys about quality concerns they identified, and reporting survey results to YESHealth members and their primary care practitioners.Results
Over 12 months, YESHealth staff visited 60 community organizations to recruit participants. Recruiting participants was challenging and ultimately required offering monetary compensation. Participants preferred telephone to online communication. Efforts to engage targeted primary care practitioners had very limited success.Conclusions
Despite these challenges, YESHealth represents a unique model for consumers' voices to try to affect change in care delivery. A randomized trial has evaluated whether the YESHealth intervention affected care quality for One Care members with disability. 相似文献10.
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Li-Ning Peng Wan-Hsuan Lu Chih-Kuang Liang Ming-Yueh Chou Chih-Ping Chung Shu-Ling Tsai Zhi-Jun Chen Fei-Yuan Hsiao Liang-Kung Chen 《Journal of the American Medical Directors Association》2017,18(11):990.e7-990.e12
Objective
To evaluate the benefits of the national stroke postacute care (PAC) program on clinical outcomes and subsequent healthcare utilization.Design
Propensity score-matched case-control study using the National Health Insurance data.Participants
A total of 1480 stroke cases receiving PAC services and 3159 matched controls with similar stroke severity but without PAC services.Measurements
Demographic characteristics, functional outcomes (modified Rankin Scale, Barthel Index, Lawton-Brody Instrumental Activities of Daily Living, Functional Oral Intake Scale, Mini-Nutritional Assessment, Berg Balance Test, Usual Gait Speed Test, 6-Minute Walk Test, Fugl-Meyer Assessment (modified sensation and motor), Mini-Mental State Examination, Motor Activity Log, and the Concise Chinese Aphasia Test), subsequent healthcare utilization (90-day stroke re-admission and emergency department visits), and 90-day mortality.Results
After propensity score matching, baseline characteristics, stroke severity, and status of healthcare utilization before index stroke admission were similar between cases and controls. After PAC services, the case group obtained significant improvement in all functional domains and may have reduced subsequent disability. Among all functional assessments, balance was the most significantly improved domain and was suggestive for the reduction of subsequent falls risk and related injuries. Compared with controls, patients receiving PAC services had significantly lower 90-day hospital re-admissions [11.1% vs 21.0%, adjusted odds ratio (aOR) 0.47 with 95% confidence interval (CI) 0.34–0.64], stroke-related re-admissions (2.1% vs 8.8%, aOR 0.22, 95% CI 0.12–0.41), and emergency department visits (13.5% vs 24.0%, aOR 0.49, 95% CI 0.37–0.65), but the 90-day mortality rate remained similar between groups (1.4% case group vs 2.0% control group, aOR 0.68, 95% CI 0.29–1.62).Conclusions
PAC significantly improved the recovery of stroke patients in all functional domains through the program, with universal interorganizational staff training, periodic functional assessment, and high-intensity rehabilitation. Further longitudinal research is needed to evaluate the long-term survival benefits and healthcare utilization. 相似文献12.
Mikaela Jorgensen Joyce Siette Andrew Georgiou Andrew Warland Johanna Westbrook 《Journal of the American Medical Directors Association》2018,19(2):117-121.e3
Objective
To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care.Design
Longitudinal cohort study using routinely collected client management data.Setting
A large aged care service provider in New South Wales and the Australian Capital Territory, Australia.Participants
A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016.Methods
Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used.Results
By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer.Conclusions
Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults’ care choices. 相似文献13.
Background
Evidence suggests there is an association between depressive symptoms and disability.Objective/Hypothesis
The objective of this study was to examine whether people with disabilities in the United Kingdom and Greece face more depressive symptoms than people without disabilities. The hypothesis was that people with disabilities in both countries are more likely to experience depressive symptoms.Methods
We used data from the 2014 European Health Interview Survey (wave 2). After performing principal-component factor analysis, we carried out logistic regressions, in order to investigate differences in depressive symptoms between people with and without disabilities, and examine the factors affecting depressive symptoms for people with disabilities.Results
People with disabilities in the UK were 2.8 times more likely to experience depressive symptoms compared to people without disabilities (95% C.I.: 2.51–3.05, p?<?.001), while in Greece, they were 2.2 times more likely to do so (95% C.I.: 1.90–2.64, p?<?.001). Our findings regarding people with disabilities showed that women, older people (in Greece), unemployed and inactive people (in Greece), and better-educated people (in the UK) were more likely to experience depressive symptoms. Married people, older people (in the UK), people living in densely-populated areas (in Greece), people who assessed their health as ‘average’ or ‘good’, and people who enjoyed social support (in Greece) were less likely to face depressive symptoms.Conclusions
Due to population-ageing and higher incidence of depressive symptoms in disabled people, it is important that policies are put in place to address the mental health needs of this population. 相似文献14.
Hillary Lum Oluyomi Obafemi Joanna Dukes Molly Nowels Kristina Samon Rebecca S. Boxer 《Journal of the American Medical Directors Association》2017,18(10):885-890
Background
Individuals with heart failure (HF) who are hospitalized and admitted to skilled nursing facilities (SNFs) are at high risk for rehospitalization and death. The care preferences of this high-risk population have not been studied.Objectives
To describe care preferences of patients with HF admitted to SNFs for rehabilitation based on Medical Orders for Scope of Treatment (MOST) documentation, and evaluate goal-concordant care based on MOST documentation, emergency department (ED) visits, and hospitalization.Design, setting, and participants
Retrospective study of patients with HF in 35 SNFs enrolled in a randomized controlled trial of HF-disease management versus usual care between July 2014 and May 2016.Measurements
Validity of MOST forms, care preference documentation, and ED visits/hospitalizations within 60 days of SNF admission.Results
Of 370 patients (mean age 78.6 years, 58% women, 25% systolic HF), 278 (75%) had a MOST form in the SNF chart, of which 96 forms (35%) were invalid. The most common reason for an invalid MOST form was missing date accompanying patient or provider signature. Of 182 valid MOST forms, 47% of patients chose no cardiopulmonary resuscitation (“No CPR”), 58% selected “Full Treatment,” 17% chose “Selective Treatment,” and 23% chose “Comfort-Focused Treatment.” Patients who were older [odds ratio (OR) = 1.50, 95% confidence interval (CI) = 1.25, 1.81] and female (OR = 2.33, 95% CI = 1.18, 4.59) had higher odds of choosing “No CPR.” Sixty-six of 182 patients (36%) with valid MOST forms had an ED/hospital visit within 60 days of SNF admission; only 3 patients received medical care that was potentially discordant: all 3 chose “Comfort-Focused Treatment” and were hospitalized for more than symptom management.Conclusion
Seventy-five percent of patients with HF admitted to SNFs had care preferences documented using the MOST form, and 95% received goal-concordant care based on care preferences documented during the SNF admission. Clinicaltrials.gov # NCT01822912. 相似文献15.
Carli Friedman 《Disability and health journal》2018,11(3):351-358
Background
The Personal Outcome Measures® is a person-centered tool to measure the quality of life (QOL) of people with disabilities, especially those who receive long term services and supports. While the outcomes examine people's satisfaction with their lives in a wide range of areas, the organizational supports determine if service agencies are appropriately supporting people with disabilities to ensure people with disabilities have the best possible QOL. The Personal Outcome Measures® has been administered to tens of thousands of people with disabilities and older adults over its twenty-five years of existence.Objective
In order for the Personal Outcome Measures® to adequately measure the QOL of people with disabilities, it must continuously be refined in alignment with the advances made by people with disabilities, and the disability service system. Therefore, the purpose of this study was to re-validate the Personal Outcome Measures®.Methods
A Principal Components Analysis was used to analyze data from 1473 people with disabilities to determine if any indicators needed to be removed as well as the underlying structure of the Personal Outcome Measures®.Results
The analysis revealed the Personal Outcome Measures® has construct validity. It also found that the 21 indicators fall into five underlying factors: my human security; my community; my relationships; my choices; and, my goals.Conclusions
Taken together these twenty-one indicators and five factors represent a multifaceted and comprehensive QOL assessment that aims to improve the lives of people with disabilities. 相似文献16.
Samuel W. Logan Kathleen R. Bogart Samantha M. Ross Erica Woekel 《Disability and health journal》2018,11(4):562-567
Background
Emergent disability studies research is interested in the community's views on how disability, including self-directed mobility, influences social and environmental policies. We anticipate that individuals' alignment with disability models, or sets of assumptions about the cause, nature, and treatment of disability, will influence attitudes about self-directed mobility. Self-directed mobility is defined as mobility that is controlled by an individual and may include walking or assisted ambulation through the use of mobility technology such as prosthetics, walking aids, manual wheelchairs, or motorized wheelchairs.Objective
The purpose of this study was to explore how demographic factors, contact with people with disabilities, attitudes toward people with disabilities, and alignment with social or medical models of disability predict attitudes toward self-directed mobility.Methods
1545 students at a public university completed demographic questions, and measures of disability attitudes, disability model orientation, and self-directed mobility.Results
The predictors explained 16.60% of the variance in participants' attitudes toward self-directed mobility (R2?=?0.166, F(7,1537)?=?43.9, p?<?.001). Significant predictors included: female gender (β?=??0.14, p?<?.01), more positive attitudes toward people with disabilities (β?=??0.30, p?<?.001), and social model orientation (β?=?0.59, p?<?.001).Conclusions
Participants who more strongly agreed with disability as a social construct (social model) were in stronger agreement that self-directed mobility is a fundamental right. Future research extending to rehabilitation professionals is warranted. 相似文献17.
Stephen P. Gulley Elizabeth K. Rasch Christina D. Bethell Adam C. Carle Benjamin G. Druss Amy J. Houtrow Amanda Reichard Leighton Chan 《Disability and health journal》2018,11(2):192-203
Background
There is a concerted effort underway to evaluate and reform our nation's approach to the health of people with ongoing or elevated needs for care, particularly persons with chronic conditions and/or disabilities.Objective
This literature review characterizes the current state of knowledge on the measurement of chronic disease and disability in population-based health services research on working age adults (age 18–64).Methods
Scoping review methods were used to scan the health services research literature published since the year 2000, including medline, psycINFO and manual searches. The guiding question was: “How are chronic conditions and disability defined and measured in studies of healthcare access, quality, utilization or cost?”Results
Fifty-five studies met the stated inclusion criteria. Chronic conditions were variously defined by brief lists of conditions, broader criteria-based lists, two or more (multiple) chronic conditions, or other constructs. Disability was generally assessed through ADLs/IADLs, functional limitations, activity limitations or program eligibility. A smaller subset of studies used information from both domains to identify a study population or to stratify it by subgroup.Conclusions
There remains a divide in this literature between studies that rely upon diagnostically-oriented measures and studies that instead rely on functional, activity or other constructs of disability to identify the population of interest. This leads to wide ranging differences in population prevalence and outcome estimates. However, there is also a growing effort to develop methods that account for the overlap between chronic disease and disability and to “segment” this heterogeneous population into policy or practice relevant subgroups. 相似文献18.
John E. Morley Hidenori Arai Li Cao Birong Dong Reshma A. Merchant Bruno Vellas Renuka Visvanathan Jean Woo 《Journal of the American Medical Directors Association》2017,18(6):489-494
Background
Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric syndromes (frailty, sarcopenia, anorexia of aging, and cognitive decline) will delay or avert the development of disability.Objectives
To identify simple screening programs available for primary health professionals to identify geriatric syndromes.Data sources
PubMed for the last 5 years and study authors.Results
A number of screening programs for early detection of geriatric syndromes have been developed for use by primary care health providers, for example, EasyCare, Gérontopôle Frailty Screening Tool, the Rapid Geriatric Assessment, the Kihon Checklist, and others.Limitations
This is an evolving area with limited information on the outcomes of intervention and possible harms.Conclusion
Validated screening programs exist but more work is required to determine their utility in improving outcomes of older persons. 相似文献19.
Ilanit Hasson-Ohayon Meiran Hason-Shaked Tamar Silberg Carmit-Noa Shpigelman David Roe 《Disability and health journal》2018,11(4):612-617
Background
Women with disabilities may face social negative attitudes with regard to their being mothers. In addition, attitudes toward different disabilities form a hierarchy, with more positive attitudes being displayed toward persons with physical disabilities than toward persons with psychiatric disabilities.Objective
Current observational study examined whether the relationship between a woman's type of disability (psychiatric vs. physical) and the social attitude towards her would be moderated by her being presented as a mother.Method
University students (N?=?100) filled out the Multidimensional Attitudes Scale Toward Persons With Disabilities and the Social Distance Scale, after reading one of six randomly assigned fictitious vignettes. The vignettes consisted of a woman with a physical disability/a woman with a psychiatric disability/a woman without a disability, who either was or was not a mother.Results
Type of disability was found to have a main effect in some attitude domains, suggesting that attitudes toward women with physical disabilities were better than attitudes towards women with psychiatric disabilities. An interaction between type of disability and motherhood was found for the interpersonal distress subscale of the attitudes scale. It was found that when women had physical disabilities, there was no change in attitude towards them regardless of whether they were presented as mothers or not; However, when the target woman had a psychiatric disability, and she was presented as a mother, negative attitudes were generated towards her.Conclusions
The study demonstrates the existence of a hierarchy of stigmatization and the effect of being a mother on stigmatization. 相似文献20.
Ineke J. Gerridzen Cees M.P.M. Hertogh Marja F. Depla Ruth B. Veenhuizen Els M.L. Verschuur Karlijn J. Joling 《Journal of the American Medical Directors Association》2018,19(3):240-247