using health care indicators to improve individual and systemic health care outcomes national core...
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Using Health Care Indicators to Improve
Individual and Systemic Health Care Outcomes
National Core Indicators (NCI) Cross-State Data & Additional Health
Indicators from North Carolina and West Virginia
Sarah Taub, HSRINASDDDS Annual Meeting
November 18, 2004
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Health & DD Research suggests prevalence of health
conditions is the same or higher in the DD population
Communication difficulties, behavioral issues and functional limitations present challenges to healthcare access & delivery
DD health tends to be overlooked by public health systems
Healthcare access is a particular concern for people living in community settings
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NCI Health Indicators
National Core Indicators are used for QualityManagement in 22+ DD service delivery systems
Sponsored by NASDDDS, coordinated nationally by Human Services Research Institute (HSRI)
Standard Consumer Survey instrument, interviewer training, and methodology
Three sources of information: self-report, proxy (informant), and case manager (file)
Two states – WV and NC – have augmented survey with additional interviews on health status and access
2003-2004 Total sample: 9,192 individuals with cognitive/developmental disabilities across 17 states
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Gender (N=9083)
55.2%
44.8% % Male
% Female
NCI Consumer Survey 2003-2004
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Level of Mental Retardation (N=8272)
No label3%
Mild39%
Moderate28%
Severe16%
Profound14%
NCI Consumer Survey 2003-2004
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Time of last physical exam by type of residence (N=8715)
91% 90%85%
73%
6% 7% 7%14%
4% 3%8%
14%
0%
20%
40%
60%
80%
100%
Specialized facility Communityresidence
Independent homeapartment
Parent/relative shome
within past year over a year ago DK
NCI Consumer Survey 2003-2004
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Time of last dentist visit by type of residence (N=8322)
63% 63%
52%
9% 9%
37%34%31%
28% 28% 30%
17%
0%
20%
40%
60%
80%
100%
Specialized facility Community residence Independent homeapartment
Parent/relative shome
within last six months over six months ago DK
NCI Consumer Survey 2003-2004
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Time of last OB/GYN by type of residence (N=3648)
66% 63% 64%
33%
16% 15% 15% 15%
5% 6% 3%
17%13% 16% 18%
35%
0%
20%
40%
60%
80%
100%
Specialized facility Communityresidence
Independent homeapartment
Parent/relative shome
within past year over a year ago never DK
NCI Consumer Survey 2003-2004
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Comparison with US Population
Source of US data: National Health Interview Survey (2002)
Visited physician in the past year
84% 83%
0%
20%
40%
60%
80%
100%
NCI US Population
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Comparison with US Population
Went to the dentist in the past 6 months
54%63%
0%
20%
40%
60%
80%
100%
NCI US Population
Source of US data: Joint Canada/United States Survey of Health (2002-2003)
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Comparison with US population
Had OB/GYN visit in the past year
54%
68%
0%
20%
40%
60%
80%
100%
NCI US Population
Source of US data: Behavioral Risk Factor Surveillance System survey (2002)
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Dual diagnosis by type of medications taken (N=6951)
15%
34%28%
23%
74%
14%
6% 5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Takes nomedications
1 type 2 types 3 types
Yes
No
NCI Consumer Survey 2003-2004
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Communication ability by type of residence (N=7761)
39%
19%5%
14%
61%
81%95%
86%
0%
20%
40%
60%
80%
100%
Specialized facility Communityresidence
Independenthome apartment
Parent/relative shome
Non verbal Verbal
NCI Consumer Survey 2003-2004
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Level of mobility by type of residence (N=8308)
66%
89% 93%87%
34%
11% 7%13%
0%
20%
40%
60%
80%
100%
Specialized facility Communityresidence
Independent homeapartment
Parent/relative shome
walks with or without aids non-ambulatory
NCI Consumer Survey 2003-2004
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Use of NCI Data to Improve Health Massachusetts DMR Health Promotion &
Coordination Initiative Tools to measure health status, manage risk Enable DSPs to be better health advocates
Rhode Island Quality Consortium Health and Safety committee reviews data and
makes recommendations to state Results used in staff training and development
Arizona focused on improving women’s health results rate of GYN exams has increased from <30%
to >70%
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For More Information NCI Website: www.hsri.org/nci Email: [email protected] Related articles published in Public Health
Reports July-August 2004 (special issue on MR population health issues) Freedman & Chassler Havercamp et al.
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Study of Health Indicators in West
Virginia
Madeleine KimmichHuman Services Research
Institute2004
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Goals of this Study
1. To assess the health care needs of West Virginians with developmental disabilities and the extent to which currently available medical and health-related services meet those needs.
2. To compare the availability of health care services for people with developmental disabilities to the larger population.
3. To expand the utility of the National Core Indicators (NCI) project for policy making in West Virginia and nationally.
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Health Interview Guide
NCI interviewers were trained to administer the health interview
The interview was conducted in conjunction with the NCI Consumer Survey
The interview contained questions relating to health care access, quality of care, complaints and emergency services
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Study Sample
Completed NCI surveys=8724 (2002)
Completed WV NCI surveys=232 Number of counties represented=45
Completed health interviews=110 Number of counties represented=42
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Topics Examined
Healthy Lifestyles Health Care Access Quality of Care Complaints Provider and Case Manager Surveys
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Healthy Lifestyles
5 questions added to West Virginia NCI Consumer Survey
Exercise, tobacco use and weight issues
Contrasted with similar national figures for the entire U.S. population
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Percent of Persons Who Have Not Participated in Physical Activity in the Past MonthGroup Percent
Persons with Developmental Disabilities in West Virginia
34%
Total West Virginia Population 29%
Total US Population 24%
Exercise/Physical Activity
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Percent of Persons Who Smoke
Group Percent
Persons with Developmental Disabilities in West Virginia
12%*
Total West Virginia Population 28%
Total US Population 23%
Tobacco Use
*This included persons who smoke or chew tobacco
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Results from Provider andCase Manager Surveys
Similar results on two key measures:• Dental care, eye care and therapy
identified as the most difficult services to access
• Geography and unwillingness to serve people with Medicaid identified as the most important factors limiting health care choice
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Conclusions:
Good access to basic medical care Insufficient awareness of dental needs Poor access to OB/GYN services
Recommendations:
Continue to track health access issues Educate consumers regarding health service
needs
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Study of Health Indicators in North
Carolina
Susan M. Havercamp, Ph.D.University of North CarolinaChapel Hill, NC 27599-7255
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Health Outcomes for 3 Groups: Adults with
Developmental Disabilities in community 2000-2001 NCNCI
Other Disabilities 2001 BRFSS
No Disability 2001 BRFSS
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Health Risk Behaviors
23 25
57
4
37
29
66
7
34
21
60
29
0
10
20
30
40
50
60
70
No Exercise pastmonth
Smoke Cigarettes Overweight/Obese(BMI)
InadequateEmotional Support
Per
cen
t
No Disability Disability Developmental Disability
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Overall Health Status
27
67
67
46 48
20
61
19
0
20
40
60
80
100
Excellent Good Fair/Poor
Per
cent
No Disability Disability Developmental Disability
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Chronic Health Conditions
21
4
15
4 4
48
23
47
15
56
16
7 58
3
0
10
20
30
40
50
60
High bloodpressure
Cardiovasculardisease
Arthritis Diabetes Chronic Pain
Per
cen
t
No Disability Disability Developmental Disability
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Conclusions Adults with DD have the same or
greater health risks as general population
They were more likely to report a sedentary lifestyle with more than ⅓ reporting no exercise in past month
Alarmingly high rate of inadequate emotional support (relative risk 7.9) and mental health problems (35%)
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Adults with DD have the same or greater risk of chronic health conditions as general population
Access to health care services is a challenge in the community Dental services and reproductive health
services for women are particularly neglected
Behavioral interventions could improve the health status of adults with DD
People living with their families have lower utilization rates of basic health care
Conclusions