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 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, 2015 to September 30, 2016, the activities conducted for this project have focused on field test design, external funding support and dissemination. The field test was designed with our colleagues at the Ohio State University Medical System. It will include approximately 900 patients and will allow us to analyze the sensitivity and specificity of the ACHCN instrument, as well as to test our subgrouping methodology. The development of the full protocol included: drafting the survey instrument (and versions intended for in-person, phone and web administration), assembling a stakeholder advisory panel, designing staffing and survey administration procedures, writing NIST and HIPPA compliant data security / confidentiality plans, and preparing necessary documents for Institutional Review Board submission. Additionally, we submitted an application for project funding to the Patient-Centered Outcomes Research Institute, as well as a letter of intent to the Robert Wood Johnson Foundation Evidence for Action Program. Finally, we made presentations on the ACHCN project at the American Public Health Association Annual conference, at the Ohio State University College of Public Health, and at Brandeis University.
