Adults with Chronic Health Care Needs

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Our key findings indicate: 1. Adults with Chronic Health Care Needs can be usefully defined at the population level as Adults with 1 ongoing physical, cognitive, or mental health conditions or difficulties functioning who 2 need health or related support services of a type or amount beyond that needed by adults of the same sex and similar age. 2. ACHCN are not a special population, but may instead comprise over half of working age persons. Thus, any screener developed to identify this population must include elements that could be used for stratification into meaningful subgroups for the purpose of informing policies, programs, and services intended to support the population. 3. Multiple chronic conditions are the norm among ACHCN, and the number of chronic conditions experienced rises with the extent of disability. 4. Among ACHCN, adults with functional limitations (in such areas as seeing, hearing, mobility and cognition) have elevated rates of need and utilization of healthcare services, while individuals with ADL and IADL limitations have the highest rates. 5. Access problems, such as delay or non-receipt of needed medical care, are significantly greater among ACHCN compared to individuals without chronic health care needs. While ACHCN are somewhat more likely to be insured than their counterparts, substantial numbers report being uninsured part or all of the average year. 6. Healthcare disparities based on race/ethnicity demonstrably affect people with disabilities. 7. Over 40 percent of all annual visits to Emergency Rooms are made by people with disabilities. From October 01, 2013 to September 30, 2014, the activities conducted for this project include: creation of a multi-panel longitudinal data file using the most recent 7 panels from the MEPS in order to examine the relationship between incident conditions and function, consistency of health care use over time, and other issues requiring longitudinal analyses of relevance to ACHCN; execution of an Inter-Agency Agreement with CDC/NCHS to conduct cognitive tests of the ACHCN screener; assistance with preparation of protocols, research plans, other documents, and clearances necessary for initiation of the cognitive tests; performance of health services research related to disability and chronic conditions; and dissemination of findings. We recently completed analyses to directly identify high-end healthcare users in the U.S. working-age (18-64) population using the MEPS. We examined the extent of overlap between this group and people with one or more chronic conditions and/or disabilities to identify specific patterns and predictors of service use as well as to recommend approaches for stratification of this group. We developed and submitted a manuscript reporting our findings to Social Science in Medicine. Publications generated by this year's research: Gulley S, Rasch EK, Chan L: When difference becomes disparity: Health status and health service utilization on the basis of race and ethnicity among U.S. adults with disabilities. Medical Care 2014; In press Rasch EK, Gulley S, Chan L: Use of Emergency Departments among Working Age Adults with Disabilities: A Problem of Access and Service Needs. Health Services Research 2013; 48(4):1334-58