Selected Health Conditions and Likelihood of Improvement with Treatment

In response to a request from the Social Security Administration (SSA), the National Academies of Sciences, Engineering, and Medicine (the National Academies) appointed a committee to conduct a study on identifying disabling medical conditions in adults that are likely to improve with treatment. Of particular interest to SSA are long-lasting conditions (12 months or more) in the categories of mental health disorders, cancers, and musculoskeletal disorders. Specifically, SSA tasked the National Academies committee with the following: 1. Identify and define the professionally accepted, standard measurements of outcomes improvement for medical conditions (for example, mortality and effectiveness of care); 2. Identify specific, long-lasting (12-month duration or longer) medical conditions for adults in the categories of mental health disorders (such as depressive disorders, anxiety disorders, attention deficit/hyperactivity disorder), cancers (such as breast, skin, thyroid), and musculoskeletal disorders (such as disorders of the back, osteoarthritis, other arthropathies) that are disabling for a length of time, but typically (for most people with the condition) do not result in permanently disabling limitations, are responsive to treatment, and, after a specific length of time of treatment, improve to the point at which the conditions are no longer disabling; and 3. For the conditions identified in Objective 2 (above): a. Describe the professionally accepted diagnostic criteria, the average age of onset, and the gender distribution for each condition; b. Identify the types of medical professionals involved in the care of a person with the condition; c. Describe the treatments used to improve a person’s functioning, the settings in which the treatments are provided, and how people are identified for the treatments; d. Describe the length of time from start of treatment until the person’s functioning improves to the point of which the condition is no longer disabling and specific ages where improvement is more probable; e. Identify the laboratory or other findings used to assess improvement, and, if patient self-report is used, identify alternative methods that can be used to achieve the same assessment; and f. Explain whether pain is associated with the condition, and, if so, describe the types of treatment prescribed to alleviate the pain (including alternatives to opioid pain management such as non-pharmacological and multimodal therapies). The findings of this National Academies study will assist SSA in the administration of its programs that provide disability benefits: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. SSDI provides disability benefits to working-age Americans who are no longer able to work due to a disabling medical condition or terminal illness. SSI provides income assistance for disabled, blind, and aged people with limited income and resources regardless of their prior participation in the labor force. Both programs share a common disability determination process administered by SSA and a common definition of disability for adults, which is “the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” SSDI and SSI beneficiaries must undergo periodic review to determine their continued eligibility. The timeframe of review varies by medical condition and is set based on SSA’s knowledge of the medical condition.