Conference
Proceedings of
National
Conference on Disability and Health
Building Bridges for
Science and Consumers
Dallas, Texas, October 14-16, 1998
CREATING A PUBLIC HEALTH FOCUS ON DISABILITY
Deborah Allen, ScD, Nancy Wilber, EdD, Laura Rauscher, MEd, Paul Tupper, BA, Dennis Heaphy, MDiv
Objectives: Presentation will describe Massachusetts' strategic planning for a new public health focus on disability. Objectives of the effort have been: (1) defining broad parameters of a model program to promote health of people with disabilities, which can serve as a basis for incremental action steps, (2) winning DPH support for this concept and allocation of resources; (3) building external support for a cross-diagnosis, lifespan approach to disability and health.
Methods: Given funding limits, emphasis has been on clarifying the totality of a program, while pursuing opportunities to implement limited components. Methods have included extensive discussion at the division, bureau and department levels and with federal funding agencies, and establishment of a broad advisory committee with interest in disability across the lifespan.
Results: Program components that emerged from planning are: 1) a broad approach to assessment; 2) initiatives which directly address consumer health needs; 3) initiatives which promote disability awareness and inclusive program design among provides; and 4) strategies to make health and disability visible to policy makers and the public. (Specific elements, as well as the broad outline of this program, will be described in the poster presentation).
Conclusion: While there are attitudinal and material barriers to design and implementation of services addressing health needs of individuals with disabilities, it is possible to make incremental changes, given a broad vision and a proactive approach.
Public Health Implications: Historically, public health neglected disability issues and individuals with disabilities. ODH funding offers an opportunity to create a locus of responsibility for lifespan attention to disability within public health.
For more information: Deborah.Allen@state.ma.us
DISABILITY: MORE THAN THE SUM OF PHYSICAL, COGNITIVE AND EMOTIONAL IMPAIRMENTS
Susan Spear Bassett, Ph.D.
Objectives: This analysis examined the incidence of disability in the community and explored the hypothesis that impairments in multiple domains (cognition, emotion and physical health) produce more than an additive increase in the risk of becoming disabled, particularly for the elderly.
Methods: This analysis used a population-based probability sample of 3,481 community-dwelling adults from the ECA program. Participants were interviewed twice, one year apart, collecting sociodemographic and medial information and administering assessment instruments for cognitive impairment and emotional difficulty. Disability was assessed twice with the Community Disability Scale (CDS), a composite of commonly used functional items. Disabled cases were defined as those having the highest 5% of scores on the CDS.
Results: The one-year incidence of disability in the community was 1.3% and was age-dependent, increasing to 26% by age 85. There were no differences by gender or race. The relative risk of becoming disabled was related to medical, cognitive and emotional impairments, with multiple impairments substantially increasing this risk. The presence of both chronic medical conditions and cognitive impairment increased the risk 25 fold.
Conclusion: The incidence of disability is higher than that reported in cross-sectional studies and the cumulative impact of multiple spheres of impairment on disability proves to be more than additive.
Public Health Implications: Attention to mental health needs is a likely avenue for intervention and treatment that may significantly reduce disability.
For more information: sbassett@welchlink.welch.jhu.edu
USING GOAL ATTAINMENT SCALING TO ASSESS PROGRAM OUTCOMES IN DISABILITY RESEARCH
Heather Becker, Ph.D. and Alexa Stuifbergen, R.N., Ph.D., F.A.A.N
Objectives: We used Goal Attainment Scaling (GAS) in a study to enhance health promotion among women with a chronic disabling condition, multiple sclerosis. GAS, a measure of treatment-induced change, was particularly appropriate for this study because the intervention was designed to be individualized to each woman's specific situation and goal setting was already an integral part of the intervention. GAS also addressed our concern that standard outcome measures would not adequately capture the short-term changes targeted during this project.
Methods: Following the lifestyle program, the group leader helped participants identify goals they felt would be achievable within the following three months in five areas: lifestyle adjustment, nutrition, physical activity, stress management, and health care responsibility. These goals became the zero points on each individual's scales. Next, they identified better and worse outcomes that were scaled from -2 to +2. Participants indicated their status on each scale prior to the lifestyle intervention, and where they were at the end of these sessions. The group leader then assessed each participant's status on each goal during the 6 weeks, three months, and six months follow-up telephone calls.
Results: Average change was greatest from pre-intervention levels to immediate post-lifestyle session levels. In most areas, scores continued to rise slightly at six weeks post-lifestyle sessions and then declined slightly, but still remained above pre-intervention levels.
Conclusions: This study provided an opportunity to integrate goal attainment scaling with supportive follow-up telephone calls. In these calls, the group leader encouraged women with multiple sclerosis and helped them problem-solve ways to overcome the barriers they encountered in attempting to achieve and maintain the lifestyle changes they had identified for themselves.
Public Health Implications: GAS may be a particularly appropriate measurement technique for interventions that focus on lifestyle changes associated with health promotion, disease prevention, and chronic disease management in which goal setting is an integral component of the program.
For more information: heatherbecker@mail.utexas.edu
Bill Bodry
Objectives: To improve functional ability in persons who have neuromuscular disorders. To avoid secondary complications due to primary disabilities through a community based center providing wellness and prevention through physical activities using both volunteer, staff and adaptive physical education trainers.
Methods: Post acute physical rehabilitation using various modalities, physical therapy, occupational therapy, speech therapy and kinesiotherapy in a storefront facility equipped with adaptive exercise and rehabilitation equipment.
Results: Reduction in declining conditions related to disuse, reduction in secondary conditions requiring acute intervention and re-hospitalization, increase independent living skills, reduce depression, improve self-image and on-going education in self help techniques.
Conclusion: Individuals who live with chronic health problems benefit in ways that not only reduce risk of secondary disabilities, but also save many dollars in related medical treatment.
Public Health Implications: Clearly, a system of independently operated non-profit centers across America could be operated on a fraction of the savings they would generate. Savings in lost human potential though unmeasureable would be substantial.
For more information: nuamputee@aol.com
VARIATIONS IN SECONDARY CONDITIONS AND HEALTH PROMOTING BEHAVIORS IN A CROSS-DISABILITY SAMPLE OF PERSONS AGING WITH POLIO, RHEUMATOID ARTHRITIS AND STROKE.
Margaret L. Campbell, Ph.D. and Debra J. Sheets, Ph.D.
Objectives: People with severe physical disabilities, acquired at different stages of the life cycle, are surviving long enough to experience both the risks and rewards of later-life. Many of these "survivors" experience the onset of new health problems and functional limitations, which further threaten their independence and increase the "cost" of disability. The objectives of this presentation are to: (1) describe the frequency of different types of secondary conditions (SC) (i.e., chronic health problems and changes in functional impairment and activity limitations) for persons aging with polio (PO), rheumatoid arthritis (RA) and stroke (ST); (2) identify who is most at-risk for SC by demographic and disability characteristics; (3) compare the prevalence of selected chronic health conditions reported by persons aging with disability to national estimates for age-matched cohorts from the National Health Interview Survey; and (4) explore the potential protective influence of heath promotion behaviors (HPB)on the frequency of SC.
Methods: Data for this presentation come from a cross-sequential, group comparison survey study funded by the National Institute of Disability and Rehabilitation Research. A total of 555 individuals participated in the study: 218 for PO, 186 for RA, and 151 ST. All participants were selected from a rehabilitation hospital or community-based sampling framework via a stratified random design based on chronological age ( 60 vs. ??), age of onset or duration of disability, and gender or ethnicity. The average age of the combined sample was 62, with an age range of 30 to 87. The duration of disability varied from a high of 49 years for PO to a low of 7 years for ST. SC were measured via self-reports of chronic health problems diagnosed or treated since the initial onset of disability and by change in the severity of disability-related impairments (i.e., pain, fatigue, muscle weakness or joint stiffness), and in the level of difficulty performing basic and instrumental activities of daily living. HPB were measured using adapted version of the Health Promoting Lifestyles Profile II by Walker and Pender (1994). Data analysis relied on contingency table analysis with chi-square statistics and analysis of variance (ANOVA) models.
Results: No between sample differences in the total number of chronic health conditions were observed. However, when these conditions are examined individually or by type of condition (mortality vs. morbidity), significant differences emerge. The frequency of SC and HPB also vary within each sample by key demographic factors such as gender, ethnicity, marital status and education.
Conclusion: Comparisons with national data suggest that persons with early-onset of physical disabilities may be at risk of "accelerated aging" because of their higher frequency of many chronic health problems compared to age-matched cohorts from the population at large.
Public Health Implications: Cross-disability comparisons of frequencies of SC and HPB provide important information for both health care professionals and disability advocates that can be useful in identifying low and high risk groups and in targeting prevention efforts more effectively.
For more information: mic@rcf.Usc.edu
TEN YEAR FOLLOW-UP OF SERUM LIPIDS IN SPINAL CORD INJURED PATIENTS: EPIDEMIOLOGY & EFFECTS OF PHYSICAL ACTIVITY
Stephen Dearwater,MS, Gilbert Brenes,MD, Diane Erdelack,LPN, Ronald E. LaPorte,Ph.D, Samuel Forjuoh,DrPH.
Objectives: Low levels of high density lipoprotein cholesterol (HDL) and physical activity (PA) are independent risk factors for cardiovascular disease (CVD). Previous cross-sectional data demonstrated extremely low HDL levels in sedentary SCI individuals and significantly higher HDL levels in SCI athletes. There are, however, no longitudinal data that evaluate whether the low HDL levels seen in SCI are maintained over time or the effects of a sedentary lifestyle on HDL cholesterol in the SCI.
Methods: Concentrations of total cholesterol (CHOL), HDL, and triglycerides (TRIG) were reassessed in 74 of 102 traumatic SCI individuals that had serum lipids measured during 1984-85. Subjects were lost to follow-up due to relocation (n=12), refusals (n=11), or were deceased (n=5). Lifestyle and PA habits were obtained via self-report.
Results: The cohort consisted of 39 quadriplegics and 35 paraplegics, 64 subjects were male, and the mean time since injury=14 yrs. HDL was essentially unchanged after 10 years of follow-up. Females continued to have significantly higher HDL levels that males in 1994. The significantly higher HDL previously observed for paraplegics compared to quadriplegics in 1984 was no longer present. HDL concentrations remained < 35 mg/dl for 42% of the cohort. CHOL, HDL and TRIG all demonstrated a strong ability to track from 1984-1994 in SCI at least 1 yr post injury in 1984 (all correlations >.66). Body mass index was inversely correlated with HDL in males (r=-.37) and females (-.46). No associations were observed for cigarette smoking or alcohol consumption. Cumulative PA (rank order based on total blocks or ramps pushed/week and days of exercise/week) demonstrated a strong dosage effect for males, though only significant for male paraplegics.
Conclusions: Lipid levels in chronic SCI appear to change little over time. The protective effect that PA exerts on HDL is seen in paraplegics more so than quadriplegics, and may be mediated by a need for greater exercise intensity.
Public Health Implications: HDL continues to remain at low levels for this cohort that would predict increased risk for CVD. Further research needs to define the optimal activity dosage that can elevate and maintain HDL at levels that don't predict increased cardiovascular risk.
For more information: sdearwat@pgh.auhs.edu
EXTREMITY ABSENCE - CAUSES AND RELATED ACTIVITY LIMITATIONS: DATA FROM THE 1994 NATIONAL HEALTH INTERVIEW SURVEY (NHIS)
Holly J. Fedeyko, M.P.H.; Donald J. Lollar, Ed.D.
Objectives: To determine the differences in activity limitation for those persons with varying causes and types of extremity absence.
Methods: Data from the 1994 NHIS Phase I Core and Disability Supplement, was obtained focusing on the causes and types of extremity absence as defined by survey methods. Data on varying activity limitations was also generated. SETS, SAS, and SUDAAN softwares were utilized.
Results: Approximately 3.5 million persons in the United States have an extremity absence (1.5 persons per 1000). Preliminary findings suggest that 60 percent of these extremity absences are due to an accident or injury whereas nearly 6 percent appear to be congenital/birth-related. Diabetes as defined by the presence of cataracts or glaucoma only appears to account for six percent of extremity absences, but this result requires further investigation. Approximately 300,000 persons in the US report their extremity absence to be a primary or secondary cause of activity limitation.
Conclusion: We will attempt to report varying differences of activity limitation based on cause and type of extremity absence.
Public Health Implications: Research and interventions can be focused on promoting healthy among activities activity-limited groups. Awareness of activity limitations related to specific causes of extremity absence will help to prevent future secondary conditions caused by activity limitations.
For more information: hbf3@cdc.gov
STATE DISABILITY INFORMATION SYSTEM CAPACITY BUILDING IN KANSAS
Michael H. Fox, Sc.D., Dee Vernberg, Ph.D., Julie Sergeant, MS.Ed
Objectives: To understand how information and data are currently being used by programs serving the disabled. To identify common characteristics that are needed to manage program services within a state public health framework. To recommend strategies for enhancing epidemiological and state management information capacity in order to better meet the needs of persons with disabilities.
Methods: Major representative programs serving the disabled in Kansas were identified. Discussions with program managers were used to summarize goals and objectives of each program. All existing standardized data elements were requested for these programs, incorporating assessment/evaluation/screening, administration, and assurance functions. The data elements were categorized (using SPSS 8.0) as part of a data inventory identifying common information characteristics shared by the different programs. Information linkages were identified so that the lead state disability unit, the Office of Injury and Disability Prevention, could facilitate program coordination better throughout the state.
Results: Analyzing and facilitating management information as a public health tool allows the state office of Injury and Disability Prevention to more effectively understand the relationship of state funded disability programs to the assessment, administration, and assurance that many programs aspire to but have difficulty achieving. This approach to information management can be used as an alternative to other state-level efforts built upon a "warehousing" concept more consistent with earlier generation computer technology, but frequently limited in their operational potential.
Conclusion: The quantity, quality, and use of management information captured by programs serving disabled persons within a given state vary enormously. Categorizing information using a public health model is helpful in identifying strengths and deficiencies in program management that link directly to client services. In Kansas, earlier efforts to "link" these information systems through a large scale warehousing project have ended in failure. The new approach, built upon understanding both local and state program information, facilitating administrative coordination between programs with mutual information and management needs, and implementing strategies that share information without jeopardizing program autonomy, offers promise to improve services for disabled populations throughout the state.
Public Health Implications: Accountability of public health programs is under increased scrutiny at all levels. While tracking outcomes for many public health programs may be premature, developing information systems that accurately and efficiently monitor assessment, administration, and assurance functions (process) both within and between local and state programs is essential if services to disabled populations are going to remain viable. Justifying funding for disabled populations is made easier with improved epidemiological and management information systems. Efforts must be encouraged to continue creating these systems as part of a comprehensive, state-wide public health capacity building strategy.
For more information: mfox@rx.pharm.ukans.edu
Gray, Susan O.
Objectives: To bring together persons with disabilities, advocates, family members, health care providers, state agencies, educators and policy makers to promote the health and wellness of persons with disabilities in New Mexico.
Methods: The Disability and Health Program, through a contractor (a local Independent Living Center) planned and coordinated arrangements for the first annual statewide conference on disability and health, entitled "Feel Great-Participate!", held in Farmington, NM June 17-19, 1998.
Results: Approximately 200 participants represented the persons with disabilities, their families, providers, other advocates, health professionals, state agencies and assistive technology vendors/specialists. Conference planners obtained much support, both financial, and in kind from community sources, freeing funds to provide scholarships and/or lodging enabling a larger attendance of persons with disabilities. Community awareness was raised regarding the needs, abilities and resources of individuals with disabilities. A CDC representative opened the conference. Conference activities included river rafting, alternative therapies, and dialogues with congressional staff representatives regarding long term services.
Conclusion: The forum was beneficial by allowing these disparate to network, to learn more about available resources, to share their own experiences regarding successes of and barriers to living well with disabilities, and to make their voices heard in their communities and to their policy makers.
Public Health Implications: The conference helped fulfill the essential public health activities of informing, educating and empowering people about health and disability issues; and mobilizing community partnerships.
For more information: susang@DOH.STATE.NM.US
PERCEPTION OF DISABILITY: PRELIMINARY FINDINGS FROM THE 1998 NORTH CAROLINA BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS).
Harry Herrick, MSPH, MSW, MEd, Kristi Passaro, PhD, Marcia Roth, MPH, Donna Scandlin, MEd, Lauren McDevitt, MS, & Carol Potter, PhD
Objective: The purpose of this study is to describe subgroup differences regarding perceptions of disability among participants in a statewide, population-based survey.
Methods: Two analysis subgroups of adults with disabilities were constructed from unweighted 1998 North Carolina BRFSS data. Group one (D1) consisted of those who responded "yes" to the question, "Do you have any type of disability?" The second group (D2) comprised those who responded "no" to that question but responded positively to at least one of the four remaining disability identification screeners, which address work limitations, learning difficulties, special equipment needs, and activity limitations. The D1 and D2 groups were compared with respect to demographic and health status characteristics.
Results: Of the 570 survey respondents included in this study, 37% reported having some sort of disability or limitation. Of these, 44% were classified as D1 and 56% as D2. About 71% of D1 respondents were aged 50 or older versus 40% of those in D2. The percentage of D1 respondents who reported an annual household income below $15,000 was more than twice that for the D2 respondents (37% vs. 12%). Nearly half (46%) of the D1 group reported their general health status to be fair or poor versus 19% of the D2 group.
Conclusions: Adult survey respondents who describe themselves as having a disability are more likely to be older, to have low incomes, and to report being in poor health than those reporting a limitation or impairment but not using the term "disability" to describe themselves.
Public Health Implications: Population-based surveys and other efforts aimed at describing the prevalence of disability should recognize that subgroups of adults with disabilities may use different terminology to define and describe their conditions and experiences.
For more information: harry_herrick@mail.ehnr.state.nc.us
GEORGIA SPECIAL OLYMPICS: SPECIAL OLYMPICS, SPECIAL SMILES DENTAL SCREENING AND ORAL HEALTH EDUCATION PROJECT
Harry Holden, Joe Alderman, John MacNamara, Norm Sterling, Jack Stubbs
Objective: To report the results of a no-cost dental screening, oral health education, nutritional counseling and information on referral to special athletes volunteering to be screened. The project also promotes increased awareness of dental professionals to the oral health needs of persons with disabilities.
Method: The dental screening project was initially established in 1994 and is conducted annually at the Georgia Special Olympics as a collaborative project between the National Special Olympics, Special Smiles Project; Georgia Special Olympics; Centers for Disease Control and Prevention; Georgia Dental Association; Georgia Dental Society; American Dietetic Association; Georgia Department of Human Resources, Division of Public Health (Oral Health Section), Division of Mental Health, Mental Retardation and Substance Abuse; Georgia ARC and three dental hygiene schools at Lanier Tech, Clayton State and Dekalb College. These agencies and organizations provide resources for non-invasive oral screening to special athletes by licensed dentists and one-on-one oral hygiene and nutritional instruction from dentist, dental hygienist and nutritionists. They also receive written results of the screening and a list of dentists in their area who provide treatment for people with special needs. In 1998, the screening and data collection process was standardized and dentists were calibrated in the use of a new screening instrument. The standardization was successful in establishing a consistent collection of screening results from all providers.
Results: Data enumerating the number of special athletes screened has been collected in an electronic format since 1995. The total number of athletes volunteering for screening each year (1994 - 1998) has ranged from 641 - 791 individuals. The data allows regarding the athletes' oral health condition to be classified the athletes into five types of referral categories: 1) Immediate Need; 2) Urgent Need; 3) Recommendation to See a Dentist; 4) Minor Conditions; and 5) Fine Condition. The data indicates that the number of acute care referrals (referral categories 1 & 2) over the four year period has been fairly constant until 1998 when it decreased. The number of acute care referrals in 1995 was 19.5 %; 1996 was 15.6%; 1997 was 18%; 1998 was 10%.
Conclusions: The number of acute care declined significantly from 1997 to 1998. This could indicate an improvement in oral health care but may be an artifact of the new standardization process. In conclusion, more longitudinal data collection utilizing the new standardized process will be necessary to provide a more meaningful trend analysis.
Public Health Implications: This project provides an indication of the special oral health care needs of persons with disabilities. It further demonstrates the necessity to document and explain the epidemiology of oral disease among persons with disabilities; oral disease as secondary conditions to disabilities; oral health access challenges; and disease prevention.
For more information: hrh0@cdc.gov
INCONTINENCE AND PROBLEMS WITH TOILETING: DATA FROM THE 1994-1995 NATIONAL HEALTH INTERVIEW SURVEY DISABILITY SUPPLEMENT
John F. Hough
Objective: To describe the epidemiologic characteristics of noninstitutionalized persons in the U. S. who experience bowel or bladder incontinence, other personal care problems related to toileting, or use colostomy devices or indwelling urinary catheters.
Methods: Analysis of variance among selected variables from the Adult Followback Survey conducted as part of the 1994-1995 Disability Supplement to the NHIS. National prevalence estimates were derived from data generated by more than 25,000 respondents. The pertinent variables included those related to demographic characteristics of the affected population; limitations in work or social activities; poverty status; health insurance status; employment status; whether an adapted restroom at a worksite would improve the respondent's employability; requirement for supervisory or standby help; and the prevalence of use of colostomy devices and urinary catheters.
Results: An estimated one percent (0.87 %, representing about 2.06 million persons) of the noninstitutionalized population reported some difficulty related to toileting. Among such persons, an estimated 840,946 (40.8 % of the subtotal) required supervision during toileting; an estimated 621,157 (30.2 %) required special equipment; and an estimated 395,702 (19.2 %) required both supervision and special equipment.
Conclusion: Incontinence and toileting difficulties are important secondary conditions that exhibit socioeconomic, employment, and social activity gradients.
Public Health Implications: Enhancing the environmental participation of incontinent persons will require broad adaptations in the home and the workplace.
For more information: jph7@cdc.gov
VULNERABILITIES FOR ABUSE AMONG WOMEN WITH DISABILITIES
Hughes, Rosemary B; Nosek, Margaret A; and, Foley, Catherine Clubb
Objectives: To identify and evaluate specific vulnerabilities for emotional, physical and sexual abuse directly attributable to disability among women with disabilities.
Methods: A national survey at the Center for Research on Women with Disabilities examined 439 women with disabilities and 421 women without disabilities. Disability-specific vulnerability factors were analyzed from the narratives of the 181 women with disabilities who responded to open-ended questions about emotional, physical, and sexual abuse.
Results: Disability-related specific vulnerabilities were identified among emotional, physical, sexual domains. Emotional vulnerabilities included threatened abandonment, institutionalization and/or rejection; unbelievability and denial; lowered self-esteem resulting from multiple forms of discrimination, ridicule and misplaced responsibility. Physical vulnerabilities involved withholding equipment and medications; lack of accessibility; and, physical restraint. Sexual vulnerabilities included exploitive behaviors and degrading attitudes about disability and sexuality; unprotected privacy; and, inescapability. In addition, disability-based factors creating risk for all three types of abuse were identified, such as the helping relationship with its potential for boundary violations; specific settings offering climates for easily undetected abuse; and, stereotyping of women with disabilities as individuals with diminished intimate desirability.
Conclusion: Disability constitutes a substantial risk factor for increasing vulnerabilities for abuse.
Public Health Implications: To enhance the health and quality of life for women with disabilities, policy and practice must respond to disability-related vulnerabilities for abuse.
For more information: rhughes@bcm.tmc.edu
SCHOOL ENVIRONMENTS OF STUDENTS WITH DISABILITIES
Gail S. Huntington, Ph.D., Rune J. Simeonsson, Ph.D., M.S.P.H., & Janey McMillen, Ph.D.
Objectives. The goal of this project is to develop and evaluate measures of participation and environment of children and youth with disabilities.
Methods. A national random sampling mail survey of teachers of special education and teachers of students with mobility impairments (N = 1200) regarding school environments and the participation of students with disabilities in school life.
Results. The modal school was described as being located in a large town, within a school district of greater than 10,000, with 750 plus students, between 30 and 50 classrooms with 20-49 teachers, but less than five special education teachers. There were over 100 students in special education, but less than 20 students with chronic conditions or disabilities not receiving special education services. Most frequently reported available educational services included speech/language services, school psychology, and occupational and physical therapies. Learning, intellectual, and motor disabilities were the most frequent disabilities and 35% of students participated in writing their IEP. Students were typically served in regular classrooms (57%), self-contained classrooms (53%), by an aide (46%), or by pull-out instruction (40%). Environmental accessibility was reported by 55% for bathroom, 46% for ramps, 21% for adapted educational aids, and 69% for required physical education. Of students with special needs, 29% participated in school activities in a similar fashion to their peers.
Conclusions. Measurement of the physical and social dimensions of school environments can document the context in which students with disabilities participate in school life.
Public Health Implications: The environment of schools should be designed to ensure physical accessibility and social participation of students with disabilities.
For more information: hunting@mail.fpg.unc.edu
THE NM PERSONAL CARE/HOME MANAGEMENT SURVEILLANCE SYSTEM
David J. Jackson, Ph.D., Wayne Honey, MPH, and Nancy Pieters, MA
Objectives: A major objective of the PC/HMSS is to develop within the constraints of the BRFSS program and the Disability and Health Program's modest budget a PC/HM Surveillance System that supports the estimation of statistically reliable prevalence rates of PC/HM cases in New Mexico. The estimation program is not limited to the population of adult persons in households with telephones, but will be comprehensive of the civilian population of the state (households and group quarters). The surveillance system will also provide estimates for metropolitan and rural divisions of the state. While its foundations are provided by the BRFSS program, the PC/HMSS is not limited to information from this single source. The system will also use related National Center for Health Statistics, Indian Health Service, New Mexico Division of Vocational Rehabilitation, US Census data, special purpose institutional surveys, and Center for Substance Abuse Treatment (SAMHSA)data. Statistical models will integrate these multiple data sources into a comprehensive PC/HM Surveillance System. While the focus of the PC/HMSS is the prevalence estimation of persons with PC/HM limitations, it will also provide data useful for the study of other disability domains, secondary conditions, risk factors, and program evaluation.
Methods: The major methodologies employed by the PC/HMSS are survey sampling and statistical modeling to combine data from multiple source for estimating the prevalence of persons with PC/HM limitations.
Results: While the system in still in an early stage of development, six months of BRFSS data will be presented to illustrate alternative analytic approaches for exploring the limited amount of PC/HM data in the 1998 BRFSS. The PC/HMSS will not be completed until early in 2000.
Conclusions: While the notion of a surveillance system that employs statistical modeling to integrate information from multiple data sources is intriguing and promising, an informed evaluation will not be possible until the system is completed.
Public Health Implications: The PC/HMSS will provide a model for the development of cost effective surveillance of PC/HM and other disability domains.
For more information: TheArabor@AOL.COM
HEALTH CARE ACCESS AND UTILIZATION PATTERNS OF PERSONS WITH SEVERE ACTIVITY LIMITATIONS
Gwyn C. Jones
Objectives: To investigate health care access and health care utilization patterns of working-aged adults 18-64 years old, who have severe activity limitations.
Methods: Data from the 1994 and 1995 National Health Interview Surveys, Core and Disability Supplement, Phase I and Phase II were analyzed. Variables addressing health care access included (1) having a usual place for medical care, (2) reported reasons for not getting health care, and (3) reported status of health insurance coverage. Variables related to health care utilization included the number of doctor visits, short-stay hospital days, and short-stay hospital episodes reported by respondents in the past 12 months prior to being interviewed.
Results: Preliminary findings from the 1994 NHIS Core and Disability Supplement Phase I data indicated that working-aged adults 18-64 years old who reported inability to perform an age-appropriate activity were more than 6 times more likely to visit a doctor and 8 times more likely to have been hospitalized during the year prior to being interviewed than were working-aged persons without activity limitations.
Conclusions: Working-aged adults with disabilities evidenced a higher health care utilization rate than persons without disabilities, but these findings do not substantiate that the care received was effective or appropriate for their needs.
Public Health Implications: Because people with disabilities represent a large minority group with complex health care needs, public health personnel are challenged to deliver appropriate clinical preventive services, provide health education and health promotion resources, and ensure continuity of care for people with disabilities in a cost-conscious managed care context.
For more information: gbj4@cdc.gov
Last reviewed November 14, 2005