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National Leadership Summit on Eliminating and Ethnic Disparities in Health: Pre-Conference Addressing the Healthcare and Wellness Needs of Women of Color with Disabilities, January 2006

Conference 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 Research

Slide 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

  • APIs - 11%
  • Whites - 4%
  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
  • Socioeconomic
  • Education

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

Thank you!

www.ahrq.gov

RCorrea@ahrq.gov

Last Revised: July 24, 2006

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