Office on DisabilityNational Leadership Summit on Eliminating and Ethnic Disparities in Health: Pre-Conference Addressing the Healthcare and Wellness Needs of Women of Color with Disabilities, January 2006Conference Presentation: Catalyzing Quality Improvements in Health Care Services for Women of Color with Disability by Rosaly Correa-de-Araujo, MD, MSc, PhD Director, Women's Health & Gender-Based ResearchSlide 1 Agency for Healthcare Research and Quality (AHRQ) Advancing Excellence in Health Care www.ahrq.gov Catalyzing Quality Improvements in Health Care Services for Women of Color with Disability Rosaly Correa-de-Araujo, MD, MSc, PhD Director, Women's Health & Gender-Based Research Pre-Conference Addressing the Healthcare & Wellness Issues of Women of Color with Disabilities, "Minding the Gap: Access, Availability, and Services National Leadership Summit on Eliminating Racial & Ethnic Disparities in Health Washington DC, Jan 8, 2006 Slide 2 Americans With Disabilities Act of 1990 - A person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such impairment, or a person who is perceived by others as having such an impairment"
Source: US Department of Justice, 2000 Slide 3 Disability in the United States - 54 million experience some level of disability
- ? are women & girls (28.6 million)
- 21% of US female population
- 53% of US disabled population
- 5.5 million - Social Security benefits
Source: Healthy People 2010; Coyle et al, 2002 Slide 4 Key Health Issues in Women with Disability - Limited research on specific needs
- Policies do not target specific needs
- Known risks & barriers
- Mental health
- Depression
- Eating disorders
- Destructive stereotypes
- Reproductive health
- Sterilizations, abortions, hysterectomies, x-rays
- Violence
- Emotional, physical, sexual abuse
- Less likely to be believed
Slide 5 Healthy People 2010 & Disability - Promote the health of people with disabilities
- Prevent secondary conditions
- Eliminate health disparities between people with and without disabilities
Slide 6 Disparities in Health Care Disability vs. No Disability - Pap smears: 69% of adult women with disability vs. 77% women without disability
- Breast exams, Mammograms: 50% women with disability aged ? 50 years vs. 56% women without disability of same age
- Providers: failure to mention or inquire about diet, exercise, pain, sleep, changes in functional status
- Non-elderly disabled Medicare beneficiaries more likely to have lower income & difficulties accessing care than elderly counterparts
Slide 7 Satisfaction with Health Care - 32.3% with difficulties in accessing doctor's office, 38.3% equipment, 22.9% washroom
- 21.9% indicated disability prevented them from accessing good primary care
- 19.4% felt primary care received was inadequate
Source: Veltman et al, 2001 and 2002 Slide 8 Perception of Quality of Primary Care among Persons w/ Physical Disability Inquiries on Health Promotion | Percentage | FA | 61.7% | E | 58.2% | V | 10% |
- 201 individuals (20% response rate), 61.2% disabled women
Equivalent to Population Census Data - Pap tests
- Mammogram referral
- BP measurement
Source: Branigan et al, 2001 Slide 9 Secondary Conditions - 170 women ages 21 to 65, with disabilities
- 96% saw provider in past 6 months
- Many lacked gynecologic cancer screening in the past 5 years
- 12 secondary complications, but only half of the women saw rehabilitative service
Preventable - Fatigue
- Spasticity
- Deconditioning
- Joint pain
- Depression
- Social isolation
Source: Coyle et al, 2002 Slide 10 Defining & Measuring Disability - Functional activity limitations
- Criteria for eligibility for a program - SSDI
Slide 11 National Healthcare Disparities Report - NHDR - Disabled elderly
Problems w/Quality of Care Problems w/Quality of Care - Poor - 6%
- High Income - 3%
Slide 12 National Healthcare Disparities Report - NHDR - Disabled elderly
Problems w/Access to Care - Hispanics- 16%
- Whites - 7%
Problems w/ Access to Care by Income Level Populations | Percentage | P | 11% | NP | 9% | MI | 7% | HI | 4% |
Slide 13 NHDR: 2002 Preventive Services for Medicare Disabled Community Residents under Age 65 Mammogram Population | Percentage | T | 48.31% | W | 44.22% | B | 52.58% | H | 49.46% |
Functional Limitation | Percentage | None | 46 | IADL only | 51 | 1 to 2 ADLS | 50 | 3 or more ADLS | 45 | At least 1 ADL/IADL | 49 |
PAP Smears Population | Percentage | T | 48.31% | W | 52.03% | B | 55.54% | H | 54.47% |
Functional Limitation | Percentage | None | 52 | IADL only | 58 | 1 to 2 ADLS | 53 | 3 or more ADLS | 44 | At least 1 ADL/IADL | 52 |
Slide 14 NHDR: 2002 Preventive Services for Medicare Disabled Community Residents under Age 65 Home FBT (W 17%; M 17%) Population | Percentage | T | 16% | W | 17% | B | 12% | H | 15% |
Functional Limitation | Percentage | None | 9 | IADL only | 18 | 1 to 2 ADLS | 19 | 3 or more ADLS | 18 | At least 1 ADL/IADL | 18 |
Colonoscopy/Sigmoidoscopy (W 34%; M 27%) Population | Percentage | T | 31% | W | 31% | B | 28% | H | 36% |
Functional Limitation | Percentage | None | 24 | IADL only | 29 | 1 to 2 ADLS | 36 | 3 or more ADLS | 32 | At least 1 ADL/IADL | 33 |
Slide 15 NHDR: 2002 Preventive Services for Medicare Disabled Community Residents under Age 65 Flu Shots (W 42%; M 43%) Population | Percentage | T | 42.42% | W | 43.28% | B | 38.5% | H | 34.82% |
Functional Limitation | Percentage | None | 37 | IADL only | 46 | 1 to 2 ADLS | 46 | 3 or more ADLS | 40 | At least 1 ADL/IADL | 44 |
Pneumonia (W 42%; M 44%) Population | Percentage | T | 43% | W | 44% | B | 42% | H | 33% |
Functional Limitation | Percentage | None | 38 | IADL only | 41 | 1 to 2 ADLS | 49 | 3 or more ADLS | 44 | At least 1 ADL/IADL | 45 |
Slide 16 NHDR: 2002 Preventive Services for Medicare Disabled Community Residents under Age 65 Bone Mass (W 32%; M 7%) Population | Percentage | T | 19% | W | 21% | B | 16% | H | 16% |
Functional Limitation | Percentage | None | 13 | IADL only | 22 | 1 to 2 ADLS | 22 | 3 or more ADLS | 16 | At least 1 ADL/IADL | 20 |
Eye Exam (W 48%; M 40%) Population | Percentage | T | 44% | W | 43% | B | 49% | H | 50% |
Functional Limitation | Percentage | None | 41 | IADL only | 42 | 1 to 2 ADLS | 49 | 3 or more ADLS | 44 | At least 1 ADL/IADL | 45 |
Slide 17 NHDR: 2002 Preventive Services for Medicare Disabled Community Residents under Age 65 Dental Care (W 35%; M 35%) Population | Percentage | T | 35% | W | 38% | B | 26% | H | 38% |
Functional Limitation | Percentage | None | 38 | IADL only | 31 | 1 to 2 ADLS | 35 | 3 or more ADLS | 36 | At least 1 ADL/IADL | 34 |
Slide 18 NHDR: 2002 Medicare Disabled Community Residents < Age 65 - Satisfaction w/ Care Care by Specialists (W 90%; M 93%) Population | Percentage | T | 92% | W | 91% | B | 97% | H | 94% |
Functional Limitation | Percentage | None | 93 | IADL only | 93 | 1 to 2 ADLS | 96 | 3 or more ADLS | 85 | At least 1 ADL/IADL | 91 |
Ease Phone Answers (W 85%; M 89%) Population | Percentage | T | 87% | W | 86% | B | 95% | H | 94% |
Functional Limitation | Percentage | None | 90 | IADL only | 87 | 1 to 2 ADLS | 90 | 3 or more ADLS | 80 | At least 1 ADL/IADL | 86 |
Slide 19 NHDR: 2002 Medicare Disabled Community Residents < Age 65 - Satisfaction w/ Care Waited at least 30' (W 30%; M 38%) Population | Percentage | T | 34% | W | 31% | B | 38% | H | 47% |
Functional Limitation | Percentage | None | 30 | IADL only | 33 | 1 to 2 ADLS | 37 | 3 or more ADLS | 34 | At least 1 ADL/IADL | 35 |
Hospital Outpatient (W 78%; M 72%) Home Health Care (W 13%; M 10%) Population | Percentage | H-OP | HHC | T | 75 | 11 | W | 74 | 11 | B | 76 | 12 | H | 73 | 9 |
Functional Limitation | Percentage | H-OP | HHC | None | 75 | 5 | IADL only | 69 | 8 | 1 to 2 ADLS | 79 | 11 | 3 or more ADLS | 75 | 23 | At least 1 ADL/IADL | 74 | 13 |
Slide 20 Challenges in Reporting on Gender, Racial/Ethnic Disparities in Disability - Data collection does not capture disability
- Problems with sample sizes
- Considerable gaps on availability of measures of functional limitations in older adults
Slide 21 Improving National Data Collection - Population specific measures
- Gender specific measures
- Going beyond the facts
- Understanding differences
- Choosing and applying best interventions
- Improving quality of care for all
- Reducing healthcare costs
Slide 22 Disparities in Health Care What We Don't Know - All reasons why and how inequalities occur
- What proportion is amenable to improvements in health care
- What local circumstances ameliorate or increase inequalities
- How and often to collect relevant data respectfully
- How to link evidence of a problem to possible solutions
Slide 23 Final Remarks - Gender, race and ethnicity disparities in health care are a concern in disability
- Women with disabilities constitute a large subset of the US population
- Health care providers have the ability and the opportunity to enhance the health, wellness and quality of care of women with disability
- Quality improvement strategies should focus on preventive services and management of secondary conditions accompanying disability
Slide 24 Final Remarks - Data collection should be improved to gather complete and appropriate information to facilitate identification and understanding of disparities in health care; to facilitate development of quality improvement strategies and to help monitor our progress in providing quality care.
Slide 25
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