Objective: To compare health maintenance procedure rates of Medicare patients with different levels of disability. Study Design: Observational study analyzing data from the 1995 Medicare Current Beneficiary Survey (MCBS, n = 15,590). Self-reported Pap smears, mammograms, and influenza and pneumococcal vaccinations were compared between groups with different levels of health-related difficulties in six activities of daily living (ADL). Results: Compared to those without disabilities, the most severely disabled women (limitations in 5 or 6 ADL) reported fewer Pap smears (age ≤70, 23% vs 41%, p < .001) and mammograms (age ≥ 50, 13% vs 44%, p < .001). In a controlled analysis, individuals with this high level of disability were 57% (95% confidence interval [CI], 33% to 72%) and 56% (95% CI, 43% to 76%) less likely to report receiving Pap smears and mammograms, respectively, compared with able-bodied women, regardless of their age, whether they were in an HMO, or whether they lived in a long-term care facility. Functional limitations were not a deterrent to receiving vaccinations. In general, patients in HMOs reported more procedures than those in fee-for-service, while those in long- term care facilities reported fewer procedures than those living in the community. Conclusions: Disability among Medicare patients is a significant, independent risk factor for not receiving mammograms and Pap smears. Efforts should be made to identify the most severely disabled because they are at particular risk.
|Original language||English (US)|
|Number of pages||5|
|Journal||Archives of Physical Medicine and Rehabilitation|
|State||Published - Jun 1999|
Bibliographical noteFunding Information:
From the Department of Rehabilitation Medicine (Drs. Ghan, Doctor, Jha) and Department of Family Medicine (Drs. Rosenblatt, Baldwin), University of Washington; and the Division of Clinical Standards and Quality, Health Care Financing Administration, Region 10 (Dr. Ghan, Dr. Lawson, Mr. Machhose), Seattle, WA. Submitted for publication August 19, 1998. Accepted in revised form January 13, 1999. Supported by grants from the Robert Wood Johnson Foundation, Princeton, NJ; and the Office of Rural Health Policy and the Agency for Health Care Policy and Research, US Public Health Service, Washington, DC. Presented in part at the annual meeting of the Association of Academic Physiatrists, February 19, 1998, San Antonio, TX. The views expressed in this article are those of the authors and not necessarily those of the Health Care Financing Administration or the University of Washington. No commercial party having a direct financial interest in tbe results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. Reprint requests to Leighton Ghan, MD, Division of Clinical Standards and Quality, Health Care Financing Administration, Region 10, 6th Avenue, Room 800, MS/RX-42, Seattle, WA 98121: Q 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation 0003-9993/99/8006-5173$3.00/O
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