# Presentation: 430630

## 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*

## 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”*

- US Department of Justice, 2000

## Disability in the United States

- 54 million experience some level of disability
- 1⁄2 are women & girls (28.6 million)
- 21% of US female population
- 53% of US disabled population
- 5.5 million – Social Security benefits

- Healthy People 2010; Coyle et al, 2002

## 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

## Healthy People 2010  & Disability

- Promote the health of people with disabilities
- Prevent secondary conditions
- Eliminate health disparities between people with and without disabilities

## 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

## 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

- Veltman et al,  2001 and 2002

## Perception of Quality of Primary Care Among Persons w/ Physical Disability

- 201 individuals (20% response rate), 61.2% disabled women
- Pap tests
- Mammogram referral
- BP measurement

**%**

**Inquiries on Health Promotion**

**Equivalent to Population **
**Census Data**

- Branigan et al, 2001

## 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
- Fatigue
- Spasticity
- Deconditioning
- Joint pain
- Depression
- Social isolation

**Preventable**

- Coyle et al, 2002

## Defining & Measuring Disability

- Functional activity limitations
- Criteria for eligibility for a program - SSDI

## National Healthcare Disparities  Report - NHDR 

**Disabled elderly**

**Problems w/**
** ****Quality of Care**
**APIs – 11%**
**Whites – 4%**

**Problems w/**
** ****Quality of Care**
**Poor - 6%**
**High Income – 3%**

## 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**

## NHDR: 2002 Preventive Services for Medicare Disabled Community Residents Under Age 65

| Functional Limitations | Percentage |
| --- | --- |
| None | 46 |
| IADL only | 51 |
| 1 to 2 ADLS | 50 |
| 3 or more ADLS | 45 |
| At least 1 ADL/IADL | 49 |

**Mammogram**

- %

- Population

| Functional Limitations | Percentage |
| --- | --- |
| None | 52 |
| IADL only | 58 |
| 1 to 2 ADLS | 53 |
| 3 or more ADLS | 44 |
| At least 1 ADL/IADL | 52 |

**PAP Smears**

- %

- Population

## NHDR: 2002 Preventive Services for Medicare Disabled Community Residents Under Age 65

| Functional Limitations | Percentage |
| --- | --- |
| None | 9 |
| IADL only | 18 |
| 1 to 2 ADLS | 19 |
| 3 or more ADLS | 18 |
| At least 1 ADL/IADL | 18 |

**Home FBT ****(W 17% ; M 17%)**

- %

- Population

| Functional Limitations | Percentage |
| --- | --- |
| None | 24 |
| IADL only | 29 |
| 1 to 2 ADLS | 36 |
| 3 or more ADLS | 32 |
| At least 1 ADL/IADL | 33 |

**Colonoscopy/Sigmoidoscopy **
**(W 34%; M 27%)**

- %

- Population

## NHDR: 2002 Preventive Services for Medicare Disabled Community Residents Under Age 65

| Functional Limitations | Percentage |
| --- | --- |
| None | 37 |
| IADL only | 46 |
| 1 to 2 ADLS | 46 |
| 3 or more ADLS | 40 |
| At least 1 ADL/IADL | 44 |

**Flu Shots ****(W 42%; M 43%)**

- %

- Population

| Functional Limitations | Percentage |
| --- | --- |
| None | 38 |
| IADL only | 41 |
| 1 to 2 ADLS | 49 |
| 3 or more ADLS | 44 |
| At least 1 ADL/IADL | 45 |

**Pneumonia ****(W 42%; M 44%)**

- %

- Population

## NHDR: 2002 Preventive Services for Medicare Disabled Community Residents Under Age 65

| Functional Limitations | Percentage |
| --- | --- |
| None | 13 |
| IADL only | 22 |
| 1 to 2 ADLS | 22 |
| 3 or more ADLS | 16 |
| At least 1 ADL/IADL | 20 |

**Bone Mass ****(W 32%; M 7%)**

- %

- Population

| Functional Limitations | Percentage |
| --- | --- |
| None | 41 |
| IADL only | 42 |
| 1 to 2 ADLS | 49 |
| 3 or more ADLS | 44 |
| At least 1 ADL/IADL | 45 |

**Eye Exam ****(W 48%; M 40%)**

- %

- Population

## NHDR: 2002 Preventive Services for Medicare Disabled Community Residents Under Age 65

| Functional Limitations | Percentage |
| --- | --- |
| None | 38 |
| IADL only | 31 |
| 1 to 2 ADLS | 35 |
| 3 or more ADLS | 36 |
| At least 1 ADL/IADL | 34 |

**Dental Care (W 35%; M 35%)**

- %

- Population

## NHDR: 2002 Medicare Disabled Community Residents < Age 65 – Satisfaction w/ Care

| Functional Limitations | Percentage |
| --- | --- |
| None | 93 |
| IADL only | 93 |
| 1 to 2 ADLS | 96 |
| 3 or more ADLS | 85 |
| At least 1 ADL/IADL | 91 |

**Care by Specialists ****(W 90%; M 93%)**

- %

- Population

| Functional Limitations | Percentage |
| --- | --- |
| None | 90 |
| IADL only | 87 |
| 1 to 2 ADLS | 90 |
| 3 or more ADLS | 80 |
| At least 1 ADL/IADL | 86 |

**Ease Phone Answers ****(W 85%; M 89%)**

- %

- Population

## NHDR: 2002 Medicare Disabled Community Residents < Age 65 – Satisfaction w/ Care

| Functional Limitations | Percentage |
| --- | --- |
| None | 30 |
| IADL only | 33 |
| 1 to 2 ADLS | 37 |
| 3 or more ADLS | 34 |
| At least 1 ADL/IADL | 35 |

**Waited at least 30’ ****(W 30%; M 38%)**

- %

- Population

| Functional Limitations | Percentage
H-OP    HHC |
| --- | --- |
| None |           5 |
| IADL only |           8 |
| 1 to 2 ADLS |         11 |
| 3 or more ADLS |         23 |
| At least 1 ADL/IADL | 74            13 |

**Hospital Outpatient ****(W 78%; M 72%)**
**Home Health Care (W 13%; M 10%)**

- %

- Population

## 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

**Socioeconomic**
**Education**

## 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

## 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

## 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

## 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.

## Thank you!

-                               _[www.ahrq.gov](http://www.ahrq.gov/)_
-                          RCorrea@ahrq.gov