using health care indicators to improve individual and systemic health care outcomes national core...

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

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

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

Gender (N=9083)

55.2%

44.8% % Male

% Female

NCI Consumer Survey 2003-2004

Level of Mental Retardation (N=8272)

No label3%

Mild39%

Moderate28%

Severe16%

Profound14%

NCI Consumer Survey 2003-2004

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

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

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

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

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)

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)

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

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

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

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%

For More Information NCI Website: www.hsri.org/nci Email: staub@hsri.org Related articles published in Public Health

Reports July-August 2004 (special issue on MR population health issues) Freedman & Chassler Havercamp et al.

Study of Health Indicators in West

Virginia

Madeleine KimmichHuman Services Research

Institute2004

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.

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

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

Topics Examined

Healthy Lifestyles Health Care Access Quality of Care Complaints Provider and Case Manager Surveys

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

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

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

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

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

Study of Health Indicators in North

Carolina

Susan M. Havercamp, Ph.D.University of North CarolinaChapel Hill, NC 27599-7255

Health Outcomes for 3 Groups: Adults with

Developmental Disabilities in community 2000-2001 NCNCI

Other Disabilities 2001 BRFSS

No Disability 2001 BRFSS

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

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

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

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%)

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