Disability, Health, and Multiple Chronic Conditions Among People Eligible for Both Medicare and Medicaid, 2005–2010.

Abstract Introduction People who are eligible for both Medicare and Medicaid (dual eligibles) and who have disabilities and multiple chronic conditions (MCC) present challenges for treatment, preventive services, and cost-effective access to care within the US health system. We sought to better understand dual eligibles and their association with MCC, accounting for sociodemographic factors inclusive of functional disability category. Methods Medical Expenditure Panel Survey (MEPS) data for 2005 through 2010 were stratified by ages 18 to 64 and 65 or older to account for unique subsets of dual eligibles. Prevalence of MCC was calculated for those with physical disabilities, physical plus cognitive disabilities, and all others, accounting for sociodemographic and health-related factors. Adjusted odds for having MCC were calculated by using logistic regression. Results Of dual eligibles aged 18 to 64, 53% had MCC compared with 73.5% of those aged 65 or older. Sixty-five percent of all dual eligibles had 2 or more chronic conditions, and among dual eligibles aged 65 or older with physical disabilities and cognitive limitations, 35% had 4 or more, with hypertension and arthritis the most common conditions. Dual eligibles aged 18 to 64 who had a usual source of medical care had a 127% increased likelihood of having MCC compared with those who did not have a usual source of care. Conclusion Attention to disability can be a component to helping further understand the relationship between health and chronic conditions for dual eligible populations and other segments of our society with complex health and medical needs

Diagnosis isn\u27t enough: Understanding the connections between high health care utilization, chronic conditions and disabilities among U.S. working age adults

Background Under the ACA, new programs are being developed to enhance care coordination and reduce health care costs among people with chronic conditions, disabilities, and high utilization of health care. However, the relationships between these groups are not well understood. Objectives Our aims were to (1) identify high utilizers of health care in the U.S. working age (18–64) population, (2) examine the overlap between this group and people with chronic conditions and/or disabilities, (3) identify predictors of high service use or cost among these subpopulations, and (4) recommend approaches for stratification of individuals with high health care utilization. Methods Using pooled national data from the Medical Expenditure Panel Survey (2006–2008), we created indices to identify elevated or high utilization and cost groups. We performed descriptive analyses, bivariate comparisons and multivariate analyses to examine the relations between these populations and individuals with chronic conditions and/or disabilities. Results While the large majority of persons with high use/cost had chronic conditions, the minority of persons with chronic conditions had high health care utilization. However, among persons with chronic conditions, disability was a significant predictor of high utilization. Annual expenditures were significantly elevated among people with disabilities, particularly when activities of daily living were limited. Conclusions We conclude that medical diagnosis alone is insufficient for the development of eligibility criteria for, or the evaluation of, programs intended to better the delivery or coordination of services for high utilizers of health care services. New approaches are needed to assess functional limitations and identify ongoing needs for services and supports

Genre, Methodology and Feminist Practice

The rainy season is not quite over although it has nearly spent itself. I drive leisurely along five miles of roller coaster highway, down and up, up and down again as I drink in the grandeur of the sunset. I come to the 'big hill', around and over which the road twines narrowly. From its summit I see at my left a deep purple canyon, green at the bottom with irrigated fields. At my right the sun is setting across a wide valley, the shadows replaced by roseate gold interrupted by the white resplendence of chalk cliffs. As if this were not sufficient, a light female rain like that which falls constantly over the home of the Corn gods, drops between me and the sun. I gasp in my inability to comprehend the sight fully as I turn my head forty-five degrees to behold a complete rainbow and behind it the thinnest slice of a new moon. (Gladys Reichard, 1934:122)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68113/2/10.1177_0308275X9301300405.pd

Testing the Feasibility of a Passive and Active Case Ascertainment System for Multiple Rare Conditions Simultaneously: The Experience in Three US States

Background: Owing to their low prevalence, single rare conditions are difficult to monitor through current state passive and active case ascertainment systems. However, such monitoring is important because, as a group, rare conditions have great impact on the health of affected individuals and the well-being of their caregivers. A viable approach could be to conduct passive and active case ascertainment of several rare conditions simultaneously. This is a report about the feasibility of such an approach. Objective: To test the feasibility of a case ascertainment system with passive and active components aimed at monitoring 3 rare conditions simultaneously in 3 states of the United States (Colorado, Kansas, and South Carolina). The 3 conditions are spina bifida, muscular dystrophy, and fragile X syndrome. Methods: Teams from each state evaluated the possibility of using current or modified versions of their local passive and active case ascertainment systems and datasets to monitor the 3 conditions. Together, these teams established the case definitions and selected the variables and the abstraction tools for the active case ascertainment approach. After testing the ability of their local passive and active case ascertainment system to capture all 3 conditions, the next steps were to report the number of cases detected actively and passively for each condition, to list the local barriers against the combined passive and active case ascertainment system, and to describe the experiences in trying to overcome these barriers. Results: During the test period, the team from South Carolina was able to collect data on all 3 conditions simultaneously for all ages. The Colorado team was also able to collect data on all 3 conditions but, because of age restrictions in its passive and active case ascertainment system, it was able to report few cases of fragile X syndrome. The team from Kansas was able to collect data only on spina bifida. For all states, the implementation of an active component of the ascertainment system was problematic. The passive component appears viable with minor modifications. Conclusions: Despite evident barriers, the joint passive and active case ascertainment of rare disorders using modified existing surveillance systems and datasets seems feasible, especially for systems that rely on passive case ascertainment

Does Type of Disability Matter to Public Health Policy and Practice?

Background: Surveillance has been insufficient to inform and evaluate public health practices for people with disabilities. No studies have investigated whether there is statistical justification for subdividing the large, heterogeneous group of people with disabilities into subpopulations, for surveillance. Methods: Pooled data from the Medical Expenditures Panel Survey (2004-2010, unweighted n=132,198) included the following disability types: physical, cognitive, visual, hearing loss, and multiple disabilities. We examined differences among the disability subgroups and the no disability group on receipt of flu shot, dental exam, and timely care; insurance status; usual source of care (USOC); mental and physical health; and multiple chronic conditions (MCC). Results: The disability subgroups were sociodemographically heterogeneous and differed from each other and the no disability group on health status (mental, physical, and MCC) and healthcare outcomes (flu shot, dental exam, timely receipt of care, USOC, insurance status). Conclusion: Findings demonstrate that disability subgroups differ in the magnitude of the disparities they experience compared to each other and to people without disabilities. Disability subgroups should be examined separately for public health measures to enable effective tailoring of public health policies and programs to better meet the needs for all people

Perspectives of Dentists, Families, and Case Managers on Dental Care for Individuals with Developmental Disabilities in Kansas.

The status of dental care for individuals with developmental disabilities in Kansas was examined. Dentists, family members, and case managers reported general, but partial, satisfaction with the availability, accessibility, appropriateness, and affordability of such care. Reasons for the results and recommendations for further improvement are discussed. For nearly 15 years, there has been a research-based consensus that people with developmental disabilities have experienced greater difficulty in securing health care than do people without disabilities. This difficulty has been especially problematic for several reasons (Palfrey, Samuels, Haynie, & Cammisa, 1994; Singer, Butler, & Palfrey, 1986). First, individuals with developmental disabilities, compared to peers in the typically developing population, have a greater variety and number of medical and dental care needs (Vittek et al., 1994; Ziring et al., 1988). Second, increased severity of a disability usually requires an increase in the amount of health care provider contacts (Boyle, Decoufle, & Yeargin-Allsopp, 1994; LaPlante, Rice, & Wenger, 1997). Third, early detection allows for prevention and potential improvements in health status and quality of life; barriers can impair health status and quality of life, yet can be cost effectiv

The Sloan Digital Sky Survey Quasar Catalog I. Early Data Release

We present the first edition of the Sloan Digital Sky Survey (SDSS) Quasar Catalog. The catalog consists of the 3814 objects (3000 discovered by the SDSS) in the initial SDSS public data release that have at least one emission line with a full width at half maximum larger than 1000 km/s, luminosities brighter than M_i^* = -23, and highly reliable redshifts. The area covered by the catalog is 494 square degrees; the majority of the objects were found in SDSS commissioning data using a multicolor selection technique. The quasar redshifts range from 0.15 to 5.03. For each object the catalog presents positions accurate to better than 0.2" rms per coordinate, five band (ugriz) CCD-based photometry with typical accuracy of 0.05 mag, radio and X-ray emission properties, and information on the morphology and selection method. Calibrated spectra of all objects in the catalog, covering the wavelength region 3800 to 9200 Angstroms at a spectral resolution of 1800-2100, are also available. Since the quasars were selected during the commissioning period, a time when the quasar selection algorithm was undergoing frequent revisions, the sample is not homogeneous and is not intended for statistical analysis.Comment: 27 pages, 4 figures, 4 tables, accepted by A

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29