catalyzing quality improvements in health care services for women of color with disability

1. 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

2. 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�

3. Disability in the United States 54 million experience some level of disability � are women & girls (28.6 million) 21% of US female population 53% of US disabled population 5.5 million � Social Security benefits

4. 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

5. Healthy People 2010 & Disability Promote the health of people with disabilities Prevent secondary conditions Eliminate health disparities between people with and without disabilities

6. Disparities in Health CareDisability 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

7. 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

8. 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

9. 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

10. Defining & Measuring Disability Functional activity limitations Criteria for eligibility for a program - SSDI

11. National Healthcare Disparities Report - NHDR Disabled elderly

12. National Healthcare Disparities Report - NHDR Disabled elderly

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

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

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

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

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

18. NHDR: 2002 Medicare Disabled Community Residents < Age 65 � Satisfaction w/ Care

19. NHDR: 2002 Medicare Disabled Community Residents < Age 65 � Satisfaction w/ Care

20. 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

21. 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

22. Disparities in Health CareWhat 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

23. 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

24. 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.

25. Thank you! www.ahrq.gov RCorrea@ahrq.gov