Our key findings indicate: 1. As determined by our expert measurement panel, 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. As determined by our secondary data analyses, ACHCN are not a special population, but may instead comprise over half of working age persons. Thus, the screener we have developed and published to identify this population includes elements that can be used for stratification into meaningful subgroups for the purpose of informing policies, programs, and services intended to support the population. 3. As also determined by our analyses, multiple chronic conditions are the norm among ACHCN, and the number of chronic conditions experienced rises with the extent of disability. 4. Most working age individuals with one or more chronic condition(s) do not have high service need or use, but among those that do, functional and activity limitations are quite common. 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, with African American and Hispanic individuals fairing worse than whites in several measures of service use and/or health insurance coverage. 7. Over 40 percent of all annual visits to Emergency Rooms are made by people with disabilities. Three key factors affect their ED use: access to regular medical care (including prescription medications), extent of disability, and the complexity of their health profiles. From October 01, 2018 to September 30, 2019, the activities conducted for this project have focused on dissemination of new secondary data analyses on key subgroups of, and issues affecting, this population. This work included the construction of a new pooled analysis file, drawn from multiple years of the Medical Expenditure Panel Survey (2010-2014). This data set was subsequently used for the development of a manuscript entitled: Serious Psychological Distress and Mental Health Treatment among U.S. Working Age Adults with Disabilities: The person, the environment, or both? This manuscript has been submitted to a scientific peer reviewed journal for consideration for publication. Final copyedits to a book chapter on the epidemiology of disability and chronic conditions in the United States and internationally were also completed and the book is now in press. Publications generated by this year's research: 1) Gulley S, Rasch EK, Bethell CD, Carle AC, Druss BG, Houtrow AJ, Reichard A, Chan L: At the intersection of chronic disease, disability and health services research: A scoping literature review. Disability and Health Journal, 2018; 11(2):192-203 2) Gulley S, Rasch EK, Altman BM, Bethell CD, Carle AC, Druss BG, Houtrow AJ, Reichard A, Chan L: Introducing the Adults with Chronic Healthcare Needs (ACHCN) definition and screening instrument: Rationale, supporting evidence and testing. Disability and Health Journal, 2018; 11(2):204-213
