Office on Disability
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
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