Office on Disability

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

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

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

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

Healthy People 2010 & Disability

• Promote the health of people with disabilities
• Prevent secondary conditions
• Eliminate health disparities between people with and without disabilities

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

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

Perception of Quality of Primary Care among Persons w/ Physical Disability

Inquiries on Health Promotion

• 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

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

Defining & Measuring Disability

• Functional activity limitations
• Criteria for eligibility for a program - SSDI

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%

   

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%

   

NHDR: 2002 Preventive Services for Medicare Disabled Community Residents under Age 65

Mammogram

PAP Smears

NHDR: 2002 Preventive Services for Medicare Disabled Community Residents under Age 65

Home FBT (W 17%; M 17%)

Colonoscopy/Sigmoidoscopy (W 34%; M 27%)

NHDR: 2002 Preventive Services for Medicare Disabled Community Residents under Age 65

Flu Shots (W 42%; M 43%)

Pneumonia (W 42%; M 44%)

NHDR: 2002 Preventive Services for Medicare Disabled Community Residents under Age 65

Bone Mass (W 32%; M 7%)

Eye Exam (W 48%; M 40%)

NHDR: 2002 Preventive Services for Medicare Disabled Community Residents under Age 65

Dental Care (W 35%; M 35%)

NHDR: 2002 Medicare Disabled Community Residents < Age 65 - Satisfaction w/ Care

Care by Specialists (W 90%; M 93%)

Ease Phone Answers (W 85%; M 89%)

NHDR: 2002 Medicare Disabled Community Residents < Age 65 - Satisfaction w/ Care

Waited at least 30' (W 30%; M 38%)

Hospital Outpatient (W 78%; M 72%)
Home Health Care (W 13%; M 10%)

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

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

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

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

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.

Thank you!

www.ahrq.gov
RCorrea@ahrq.gov