Identification of Potential Disability Measures for the National Healthcare Quality and Disparities Report Frances Chevarley, Barbara Altman, Ernest Moy 2007 APHA Annual Meeting--Session 3211.0, Nov 5, 2007, 1:15 pm

Overview Background of the National Healthcare Disparities and Quality Reports NHDR Disability Working Group Measurement of Disability Where the group came out Future plans

NHQR & NHDR Congressional Mandate Annual reports on “National trends in the quality of health care provided to the American people” “Prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations” Priority Populations Low-income Minorities Women Children Elderly Special health care needs Disability Chronic care End of life

NHQR & NHDR How they are Related Snapshot of quality of health care in America Snapshot of disparities in health care in American Quality Quality + Access Variation across states Variation across populations

Individuals with Disabilities in the 2003-2006 NHDRs NHDR at www.ahrq.gov Section on disabilities in the Priority Populations Chapter—very short Children with special health care needs MEPS National Survey of Children with Special Health Care Needs (2004) Adults with disabilities MCBS Medicare beneficiaries <65 Medicare beneficiaries 65+ with one or more ADL/IADLs

Disability Working Group Charge to this Group Representatives from AHRQ, AoA, ASPE, CDC-NCHS, CDC-NCBDDD, Census Bureau, CMS, HHS-OoD, NCD, NIDRR, NIH-NIA, NIH-NCMRR, HRSA, SAMHSA, SSA, VA Recommend a consensus measurement of individuals with disabilities Applicable across multiple data sources MEPS, NHIS, MCBS, ?? Can be described to lay persons in a half page Allows comparisons by race, ethnicity, and income Sensitive to sample size limitations

Objective of Working Group Reflect the ADA definition of Disability Locate the area of consistency among the various data sets used in the two reports: MEPS NHIS MCBS ?

Basis for Definition ADA definition of Disability Has a physical or mental impairment that substantially limits one or more major life activities; or Has a record of a substantially limiting impairment; or Is regarded as having such an impairment Ref – The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities 2005

Tool to Guide Process Used International Classification of Functioning, Disability and Health (ICF) Model as a guide to the conceptual components of the definition Components of ICF Body functions Body structures Activities and Participation Environmental Factors

Identifying Domains of the ICF in the Survey Questions Examples of Domains within ICF Components Body Functions and structures Sensory functions and pain The eye, ear, and related structures Activities and Participation Learning and applying knowledge Purposeful sensory experience Applying knowledge Mobility Community, social and civic life

Identifying Domains of the ICF in the Survey Questions Chapters of the Activities and Participation Component in which NHIS, MEPS, SIPP, NHANES, and MCBS all capture Learning and applying knowledge—Chapter 1 (d110-d199) Purposeful sensory experience Applying knowledge Mobility – Chapter 4 (d410-d499) Selfcare – Chapter 5 (d510-d599) Domestic Life – Chapter 6 (d610-d699) Major life areas – Chapter 8 (d810-d899) Community, social and civic life – Ch 9 (d910-d999) Survey Estimates by Domain Ref.— relied heavily on crosswalk by Cille Kennedy, ASPE

Brief Data Review Disability is a continuum and not a dichotomous concept Disability manifests itself across multiple domains Disability can be short-lived or can be chronic or sporadic

Brief Data Review Surveys have different purposes capture different # of disability questions Surveys capture different domains and at different parts of the continuum Survey tools to measure disability are not as precise as measurement tools for physical sciences

How NHIS and MEPS compare by Domain Selfcare (ADLs) NHIS —(Family Core) Screener Question (needs help of other persons) Needs help with at least 1 of 6 specific items MEPS Screener Question (receive help or supervision) Expect to need help for at least 3 more months

How NHIS and MEPS compare by Domain Mobility NHIS (Sample Adult) Not at all difficult, Only a little difficult, Somewhat difficult, Very difficult, Can’t do at all, Do not do this activity MEPS individual questions No difficulty, Some difficulty, A lot of difficulty, Completely unable to do it

How NHIS and MEPS compare by Domain Hearing NHIS (Adult Core) Which statement best describes your hearing without a hearing aid: good, a little trouble, a lot of trouble, deaf? MEPS Screener – anyone with difficulty hearing not hear any speech at all, that is deaf (w/ a hearing aid) hear most of the things people say (w/ a hearing aid) hear some of the things people say

Data Nuances due to Different questions/responses Doing a crosswalk/translation with the ICF is not always straightforward (e.g., ADLs and IADLs do not map completely to a chapter) A number of the domains have similar questions and estimates across MEPS and NHIS In some domains, like Mobility, the questions are similar but the response options are very different Different questions and/or different response options may produce different estimates

NHDR Disability Workgroup Recommendation Broad inclusive definition of Disability Focus within Activity limitations Basic activities Complex activities

NHDR Disability Workgroup Recommendation Activity limitations Basic activities mobility, self care (ADLs), domestic life (IADLs), activities dependent on sensory functioning Complex activities limitations experienced in work; and in community, social and civic life activities

2007 NHDR--Tentative Current plans for 2007 NHDR Include MEPS disability data for adults Use recommended two measures Add charts and text to Chapter 4 Priority Populations Include disability measures for ~50 MEPS tables in the Technical Appendix Each MEPS table includes 4 tables (race, ethnicity, education, and income)--total tables ~ 200

Exploratory analysis for 2007 NHDR: Adults unable to receive or delayed in receiving needed medical care

Future Plans--Tentative Plans for future NHDR reports Expand disability data by including comparable disability data from NHIS and MCBS Include additional tables/text/charts Create similar working group to discuss options for measuring disability for children Consider Including disability data from more data sources Evolving process