Adults with Chronic Health Care Needs

我们的主要发现表明： 1. 有慢性医疗保健需求的成年人可在人群水平上有效地定义为患有持续性身体、认知或精神健康状况或功能障碍的成年人，他们需要的健康或相关支持服务的类型或数量超过相同性别和相似年龄的成年人所需的。 2. ACHCN不是一个特殊的人口，但可能包括一半以上的工作年龄人口。 因此，为识别这一人群而开发的任何筛选工具都必须包括可用于分层为有意义的亚组的要素，以便为旨在支持这一人群的政策、计划和服务提供信息。 3. 多种慢性病是ACHCN的常态，经历的慢性病的数量随着残疾程度的增加而增加。 4. 在ACHCN中，有功能限制的成年人（在视觉，听觉，移动性和认知等领域）对医疗保健服务的需求和利用率较高，而ADL和IADL限制的人的需求和利用率最高。 5. 与没有慢性医疗保健需求的个人相比，ACHCN的获得问题，如延迟或不接受所需的医疗保健，要大得多。 虽然ACHCN比他们的同行更有可能投保，但相当多的人报告说，平均每年部分或全部没有保险。 6. 基于种族/族裔的保健差异明显影响残疾人。 7. 超过40%的急诊室年度访问是由残疾人。 从2013年10月1日至2014年9月30日，为该项目开展的活动包括：使用MEPS的最新7个面板创建多面板纵向数据文件，以检查事件条件与功能之间的关系、医疗保健使用随时间的一致性以及需要与ACHCN相关的纵向分析的其他问题;执行与疾病预防控制中心/国家卫生中心的机构间协议，对ACHCN筛查者进行认知测试;协助编写协议、研究计划、其他文件和启动认知测试所需的许可;开展与残疾和慢性病有关的卫生服务研究;传播研究结果。 我们最近完成了分析，使用MEPS直接识别美国工作年龄（18-64岁）人群中的高端医疗保健用户。 我们研究了这一组和一个或多个慢性疾病和/或残疾的人之间的重叠程度，以确定特定的模式和预测的服务使用，以及建议的方法分层这一组。 我们开发并提交了一份手稿，报告我们的发现，以社会科学医学。 本年度研究产生的出版物： Gulley S，Rasch EK，Chan L：当差异成为差距：美国残疾成年人基于种族和民族的健康状况和卫生服务利用。医疗保健2014;在新闻 Rasch EK，Gulley S，Chan L：工作年龄残疾成年人使用急诊室：访问和服务需求的问题。 卫生服务研究2013; 48（4）：1334-58

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