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US residents can face serious financial barriers to obtaining prescription medications, including disease-modifying medications for multiple sclerosis (MS). We conducted 30-min telephone surveys with 983 persons with MS nationwide, 21-64 years old, to explore how financial and health insurance concerns affect access to services including MS drugs. Almost everyone (96.3%) had some health insurance. Multivariable logistic regression analyses accounted for demographic, disease and insurance characteristics. Only 10.8% of those <40 years old had never received disease-modifying medications, compared with 41.1% of persons aged 60-64. Among the uninsured, 36.8% reported having never taken these medications, compared with 21.2% of persons with health insurance. Adjusted odds ratio (95% CI) of using these drugs in prior 12 months among the uninsured (compared with insured persons) was 0.28 (0.08, 0.95). Just over 16% of persons with public health plans reported that their insurer initially denied coverage for MS medication. When asked about MS medications in general, 22.3% reported having not filled prescriptions, skipping doses or splitting pills because of cost concerns; 22.4% worried 'a lot' about getting MS medications when they needed them. Substantial fractions of persons with MS confront financial and health plan-related barriers to obtaining MS drugs. [ABSTRACT FROM AUTHOR]

Working-age Americans with multiple sclerosis (MS) may face considerable financial insecurities when they become unable to work and lack the health, disability, and life insurance typically offered through employers. In order to estimate the rates of having these insurance policies, as well as how insurance status affects reports of financial stress, we conducted half-hour telephone interviews with 983 working-age persons across the US, who reported being diagnosed with MS. The interviews occurred from May through November 2005, and among the sampled individuals contacted and confirmed eligible, 93.2% completed the interview. The study population was largely female (78.9%), Caucasian (86.4%), married (68.6%), with at least some college education (71.5%), and unemployed (60.2%). Overall, 96.3% had some health insurance (40.3% with public health insurance, primarily Medicare), 56.7% had long-term disability insurance (36.4% with public programs), and 68.3% had life insurance. Notably, 27.4% indicated that, since being diagnosed with MS, health insurance concerns had significantly affected employment decisions. In addition, 16.4% reported considerable difficulty paying for health care, 27.4% put off or postponed seeking needed health care because of costs, and 22.3% delayed filling prescriptions, skipped medication doses, or split pills because of costs. Overall, 26.6% reported considerable worries about affording even basic necessities, such as food, utilities, and housing. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQL) is optimally reported from the individual vantage point; consequently, prevalence estimates from the National Health Interview Survey (NHIS) could be misleading, because approximately one third of the information is proxy-provided.Objective: The objective of this study was to discern the degree to which disparities in the crude prevalence of reduced HRQL is explainable by case-mix differences between proxy- and self-reportees.Subjects: We studied the cross-sectional data on 96,091 persons from the 1994-1995 NHIS Supplement on Disability.Research Design: We conducted a study of reduced HRQL expressed as a respondent type indicator (proxy vs. self) adjusting for socioeconomic differences and limitations in function.Measures: We studied reduced HRQL indicated by 1) perception of poor health, 2) perception of disability, 3) 30 or more bed days in the last year, or 4) 20 or more doctor visits in the last year.Results: The crude estimated prevalence of reduced HRQL for proxy reports was approximately half that of self-reports. Although the unadjusted odds ratios (ORs) for proxy- compared with self-reportees ranged from 0.51 (95% confidence interval [CI], 0.47-0.55) to 0.59 (95% CI, 0.55-0.64), case-mix adjustment resulted in a significant directional change for poor health perception, and all adjusted ORs were substantially closer to 1.0 than their unadjusted counterparts.Conclusion: Adjustment for case-mix explained away most of the proxy-/self-report disparity, suggesting that a major component of differences in prevalence between proxy- and self-respondents is case-mix-related. Consequently, compared with excluding proxy reports, inclusion of proxy reports results in relatively less bias when the NHIS-D is applied to obtain prevalence estimates for the indicators studied. [ABSTRACT FROM AUTHOR]

Roughly 54 million Americans have some disability; at older ages, women are more likely to be disabled than men. Many people with disabilities today live virtually normal life spans, and therefore routine screening and preventive services are essential to their overall quality of care. We used the 1994-1995 National Health Interview Survey (NHIS), with Disability, Family Resources, and Healthy People 2000 supplements, to examine screening and preventive service use for adult women with disabilities living in the community--about 18.4% of women (estimated 18.28 million). Disability was associated with higher age-adjusted rates of: poverty; living alone; low education; inability to work; obesity; and being frequently depressed or anxious. Disabled women generally reported screening and preventive services at rates comparable to all women. Women with major lower extremity mobility difficulties had much lower adjusted odds of Papanicolaou smears (odds ratio, 0.6; 95% confidence interval, 0.4-0.9), mammograms (odds ratio, 0.7; 95% confidence interval, 0.5-0.9), and smoking queries (odds ratio, 0.6; 95% confidence interval, 0.5-0.8). Various approaches exist to improve access for disabled women to health care services. [ABSTRACT FROM AUTHOR]

Background: Lower extremity mobility difficulties often result from common medical conditions and can disrupt both physical and emotional well-being.Objectives: To assess the national prevalence of mobility difficulties among noninstitutionalized adults and to examine associations with demographic characteristics and other physical and mental health problems.Design: Cross-sectional survey using the 1994-1995 National Health Interview Survey-Disability Supplement (NHIS-D). We constructed measures of minor, moderate, and major lower extremity mobility difficulties using questions about ability to walk, climb stairs, and stand, and use of mobility aids (e.g., canes, wheelchairs). Age and gender adjustment used direct standardization methods in Software for the Statistical Analysis of Correlated Data (SUDAAN).Participants: Noninstitutionalized, civilian U.S. residents aged 18 years and older. National Health Interview Survey sampling weights with SUDAAN provided nationally representative population estimates.Results: An estimated 19 million people (10.1%) reported some mobility difficulty. The mean age of those with minor, moderate, or major difficulty ranged from 59 to 67 years. Of those reporting major difficulties, 32% said their problems began at aged 50 years or younger. Adjusted problem rates were higher among women (11.8%) than men (8.8%), and higher among African American (15.0%) than whites (10.0%). Persons with mobility difficulties were more likely to be poorly educated, living alone, impoverished, obese, and having problems conducting daily activities. Among persons with major mobility difficulties, 30.6% reported being frequently depressed or anxious, compared to 3.8% for persons without mobility difficulties.Conclusions: Reports of mobility difficulties are common, including among middle-aged adults. Associations with poor performance of daily activities, depression, anxiety, and poverty highlight the need for comprehensive care for persons with mobility problems. [ABSTRACT FROM AUTHOR]

Presents the medical case of a 44-year-old woman with amyotrophic lateral sclerosis (ALS) who is having increasing difficulty ambulating. Symptoms; Views of the patient and doctor on her condition; Prevalence of disability and impaired mobility in the United States; Psychosocial and emotional effects of impaired mobility; Role of health professionals in addressing mobility impairments; Mobility aids; Health insurance and financial implications; Resources.

We aim to develop and validate a questionnaire that examines quality of care from the patient's perspective for limited-English-proficient Asian Americans (AA) of Chinese and Vietnamese descent. We will conduct focus groups of patients to identify issues important to them, with an emphasis on communication and access to care. We will then draft a questionnaire and test its validity using standard survey research methods and direct observation of patient-provider encounters. Subsequent field testing will involve face-to-face patient interviews 1 month after an outpatient visit. We will evaluate alternate modes of administration to test feasibility and to maximize response. The result of our study will be a validated, culturally sensitive, patient-centered instrument that measures health care quality for limited-English-proficient AA patients. Our research will provide a template for developing future quality measures for other vulnerable populations. [ABSTRACT FROM PUBLISHER]

Administrative data result from administering health care delivery, enrolling members into health insurance plans, and reimbursing for services. The primary producers of administrative data are the federal government, state governments, and private health care insurers. Although the clinical content of administrative data includes only the demographic characteristics and diagnoses of patients and codes for procedures, these data are often used to evaluate the quality of health care. Administrative data are readily available, are inexpensive to acquire, are computer readable, and typically encompass large populations. They have identified startling practice variations across small geographic areas and-supported research about outcomes of care. Many hospital report cards (which compare patient mortality rates) and physician profiles (which compare resource consumption) are derived from administrative data. However, gaps in clinical information and the billing context compromise the ability to derive valid quality appraisals from administrative data. With some exceptions, administrative data allow limited insight into the quality of processes of care, errors of omission or commission, and the appropriateness of care. In addition, questions about the accuracy and completeness of administrative data abound. Current administrative data are probably most useful as screening tools that highlight areas in which quality should be investigated in greater depth. The growing availability of electronic clinical information will change the nature of administrative data in the future, enhancing opportunities for quality measurement. [ABSTRACT FROM AUTHOR]

Study Objective: To evaluate the appropriateness of diagnostic coding of acute myocardial infarction across teaching and nonteaching hospitals.Design: Retrospective review of a random sample of medical records to find evidence of the occurrence and active treatment of acute myocardial infarction during the admission.Setting: Five tertiary teaching, five other teaching, and five nonteaching hospitals in metropolitan Boston.Cases: Random sample of hospital admissions assigned a discharge diagnosis of acute myocardial infarction between October 1984 and September 1985.Measurement and Main Results: Of the 1003 cases reviewed, 260 did not meet the clinical criteria for acute myocardial infarction. At tertiary hospitals, 175 (41.7%) failed to qualify, compared with 25 (9.1%) at nonteaching facilities. In a large fraction of the disqualified cases, the patients had been admitted to exclude the diagnosis of acute myocardial infarction; although explicitly "ruled out," an acute myocardial infarction code was assigned. Sixty-six cases from teaching hospitals did not qualify because the patient had been admitted only for coronary angiography after an uneventful postmyocardial infarction course. Almost one-third of these patients had had their infarcts from 5 to 8 weeks before the angiography admission.Conclusions: Cases with an inappropriate discharge diagnosis of acute myocardial infarction may be concentrated in teaching hospitals. This finding could have implications for Medicare's diagnosis-related group payment system and governmental and other research efforts that use these data for such purposes as drawing inferences about the quality of hospital care. [ABSTRACT FROM AUTHOR]