Chan Leighton, Ciol Marcia A, Shumway-Cook Anne, Yorkston Kathryn M, Dudgeon Brian J, Asch Steven M, Hoffman Jeanne M
Rehabilitation Medicine Department, Clinical Research Center, National Institutes of Health, Bethesda, MD 20892-1604, USA.
Arch Phys Med Rehabil. 2008 Jun;89(6):1023-30. doi: 10.1016/j.apmr.2007.10.045.
To assess, using a longitudinal definition, the impact of disability on a broad range of objective health care quality indicators.
Longitudinal cohort study following up with patients over several years. The first 2 interviews, 1 year apart, were used to determine each patient's disability status in activities of daily living (ADLs). Assessment of the health care indicators commenced after the second interview and continued throughout the survey period (an additional 1-3y).
National survey.
Participants (N=29,074) of the Medicare Current Beneficiary Survey (1992-2001) with no, increasing, decreasing, and stable ADL disability.
Not applicable.
The incidence of 5 avoidable outcomes, receipt of 3 preventive care measures, and adherence to 32 diagnostically based indicators assessing the quality of treatment for acute myocardial infarction [AMI], angina, breast cancer, cerebrovascular accident, transient ischemic attack, cholelithiasis, chronic obstructive pulmonary disease [COPD], congestive heart failure, depression, gastrointestinal bleeding, diabetes, and hypertension.
For most indicators, less than 75% of eligible patients received necessary care, regardless of disability status. For 5 indicators, less than 50% of patients received appropriate treatment. In a logistic regression analysis that controlled for patient age, sex, race, and income, disability status was a significant factor in 7 quality measures (AMI, breast cancer, COPD, diabetes, angina, pneumonia, annual visits).
Using a longitudinal definition of disability and objective health quality indicators, we found that disability status can be an important factor in determining receipt of quality health care in a broad range of diagnostic categories. However, the impact of disability status varies depending on the indicator measured. In this cohort of patients, the changing nature of a person's disability seems to have less impact than whether they ever have had any functional deficits.
采用纵向定义评估残疾对一系列广泛的客观医疗质量指标的影响。
对患者进行数年随访的纵向队列研究。相隔1年的前两次访谈用于确定每位患者在日常生活活动（ADL）中的残疾状况。医疗指标评估在第二次访谈后开始，并在整个调查期间（另外1 - 3年）持续进行。
全国性调查。
医疗保险当前受益人调查（1992 - 2001年）中的参与者（N = 29,074），他们在ADL方面无残疾、残疾程度增加、残疾程度降低或残疾状况稳定。
不适用。
5种可避免结局的发生率、3种预防性护理措施的接受情况，以及对32项基于诊断的指标的依从性，这些指标评估急性心肌梗死（AMI）、心绞痛、乳腺癌、脑血管意外、短暂性脑缺血发作、胆石症、慢性阻塞性肺疾病（COPD）、充血性心力衰竭、抑郁症、胃肠道出血、糖尿病和高血压的治疗质量。
对于大多数指标，无论残疾状况如何，不到75%的符合条件患者接受了必要的护理。对于5项指标，不到50%的患者接受了适当的治疗。在控制了患者年龄、性别、种族和收入的逻辑回归分析中，残疾状况是7项质量指标（AMI、乳腺癌、COPD、糖尿病、心绞痛、肺炎、年度就诊）的重要因素。
采用残疾的纵向定义和客观的健康质量指标，我们发现残疾状况可能是决定广泛诊断类别中优质医疗服务接受情况的重要因素。然而，残疾状况的影响因所测量的指标而异。在这组患者中，一个人残疾性质的变化似乎比他们是否曾经有任何功能缺陷的影响更小。
