In their """"""""Consumer Bill of Rights and Responsibilities,"""""""" the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry noted that today's health care consumers report """"""""poor communication with their doctor, feeling rushed or ignored, lack of dignity during examinations, ..., receiving inadequate explanations or advice, [and] having inadequate time with the doctor during routine visits,"""""""" among other complaints. While many consumers share these concerns, persons with disabilities are especially vulnerable to substandard health care. Many factors affect their care - ranging from short times available to address complex issues with clinicians to sensory and cognitive communication barriers to limited financial resources to physically inaccessible care sites. Using both quantitative analyses of existing surveys and qualitative analyses of interviews, our goal is to understand the role of disability in experiencing poor quality care, along various dimensions. We shall focus on access to care, use of primary care and preventive services, and the role of different types of physicians (e.g., specialists versus primary care) in meeting patients' needs. Quality will be examined within categories of disabilities, defined considering both functional and medical aspects of disabling conditions. We shall analyze data from three national surveys: (1) the 1994 and 1995 National Health Interview Survey Disability Supplement, merged with information from the Family Resources and Healthy People 2000 supplements; (2) the Medical Expenditure Panel Survey; and (3) the Medicare Current Beneficiary Survey, including information from Medicare claims. To obtain direct, experiential insight, we shall conduct: interviews of persons with disabilities; interviews with primary care and specialist physicians; and site visits to physicians' clinics and offices. Additional interviews with key informants, representing advocates for persons with disabilities, physician organizations, and experts in measuring and improving quality of health care, will guide the analysis. Using both the survey results and experiential findings, we shall develop specific recommendations for targeting interventions and improving quality of care for people with disabilities. Given that roughly 49 million Americans have a disabling condition, addressing concerns about their quality of care is essential.
| Weil, Evette; Wachterman, Melissa; McCarthy, Ellen P et al. (2002) Obesity among adults with disabling conditions. JAMA 288:1265-8 |
