National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Building 10, CRC, Room 1-1469, 10 Center Dr., MSC-1604, Bethesda, MD 20892-1604, USA.
Public Health Rep. 2011 Jul-Aug;126(4):495-507. doi: 10.1177/003335491112600406.
A critical issue in health-care reform concerns how to realign health-care delivery systems to manage medical care services for people with ongoing and costly needs for care. We examined the overlapping health-care needs of two such population groups among the U.S. working-age population (those aged 18-64 years): people with chronic medical conditions and people with disabilities.
Using the Medical Expenditure Panel Survey (2002-2004), we examined differences in health status, service use, and access to care among and between working-age adults reporting disabilities and/or one or more chronic conditions. We also analyzed people with three key chronic conditions: arthritis, diabetes, and depression.
More than half of working-age people with disabilities reported having more than one chronic condition. Among those with activities of daily living or instrumental activities of daily living limitations, 35% reported four or more chronic conditions at a time. We found considerable variability in access problems and service use depending on how we accounted for the overlap of multiple conditions among people with arthritis, diabetes, and depression. However, disability consistently predicted higher emergency department use, higher hospitalization rates, and greater access problems.
The overall prevalence of chronic conditions among the U.S. working-age population, coupled with the high concentration of multiple chronic conditions among those with disabilities, underscores the importance of reforming health-care delivery systems to provide person-centered care over time. New policy-relevant measures that transcend diagnosis are required to track the ongoing needs for health services that these populations present.
医疗改革的一个关键问题是如何调整医疗服务提供系统，以管理有持续和昂贵护理需求的人群的医疗服务。我们研究了美国劳动年龄人群（18-64 岁）中两类具有重叠医疗需求的人群：患有慢性疾病的人群和残疾人群。
利用医疗支出面板调查（2002-2004 年），我们研究了报告残疾和/或一种或多种慢性疾病的劳动年龄成年人之间和之间在健康状况、服务使用和获得护理方面的差异。我们还分析了患有三种主要慢性病的人群：关节炎、糖尿病和抑郁症。
超过一半的残疾劳动年龄人群报告患有一种以上的慢性疾病。在日常生活活动或工具性日常生活活动受限的人群中，35%的人一次报告有四种或更多的慢性疾病。我们发现，根据我们如何解释关节炎、糖尿病和抑郁症患者多种疾病的重叠情况，获得服务方面的问题和服务使用存在相当大的差异。然而，残疾情况始终预测急诊部门使用率更高、住院率更高和获得服务方面的问题更多。
美国劳动年龄人群中慢性疾病的总体流行率，加上残疾人群中多种慢性疾病的高度集中，突显了改革医疗服务提供系统以提供长期以患者为中心的护理的重要性。需要制定新的与政策相关的、超越诊断的措施，以跟踪这些人群呈现的持续的卫生服务需求。
