Skip to main content

Currently Skimming:

2 Overview
Pages 3-22

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 3...
... Eva Marie Stahl, director of the Community Catalyst Children's Health Project at Community Catalyst,2 and Rosa Palacios, consumer engagement specialist with the Center for Consumer Engagement in Health Innovation at Community Catalyst, then discussed the intersection of health equity, disability, and health literacy; described some of their organization's efforts to advance health literacy among those with disabilities; and presented some evidence-based strategies for self-management that are working in communities today. An open discussion, moderated by Antonia Villarruel, professor and the Margaret Bond Simon Dean of Nursing at the University of Pennsylvania, followed the presentations.
From page 4...
... These measures, however, will not in themselves transform a system that fails to recognize the presence of inequality and discrimination in the documented health disparities and unequal access experienced by people with disabilities. "We cannot move forward into a demographic analysis of how race and ethnicity intersect with disability or a discussion of supports and legal protections for people with disabilities until we recognize how deeply every socioeconomic characteristic associated with disability is 3  This section is based on the presentation by Susan Havercamp, associate professor of psy chiatry and psychology at The Ohio State University's Nisonger Center, and Silvia Yee, senior staff attorney at the Disability Rights Education and Defense Fund, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
From page 5...
... Havercamp said that while public health and policy experts agree on the need to assess health disparities and health care inequities experienced by historically disadvantaged groups and subpopulations of interest, these assessments often fail to consider the significance of collecting data on members of historically disadvantaged groups with disabilities. "All health equity research must include disability in the form of disability-related FIGURE 2-1  Physical disability by race/ethnicity from the National Health Information Survey.
From page 6...
... . In the commissioned paper accompanying this Proceedings of a Workshop, she and her co-authors recommend that all researchers who investigate health equity, health disparities, or social determinants of health of people of color and other historically underrepresented groups and who seek to collect population data should include at a minimum the six markers listed in the U.S.
From page 7...
... "People with disabilities are not destined for a life of poor health status by virtue of their disability," said Havercamp. "Rather, it is the lack of institutional support for this underserved population that contributes to the poor health outcomes, a phenomenon seen among all historically underserved populations." She noted that, just as stereotypes about certain racial and ethnic groups by health care providers can negatively affect health outcomes and contribute to health disparities, negative attitudes toward and assumptions about disabilities have an adverse impact on the health and the quality of health care for people with disabilities.
From page 8...
... The Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine can be credited, said Havercamp, with drawing attention to the importance of adapting health information to the everyday lives of people and their communities. Doing so requires understanding the cultural context of the family, which must include disability.
From page 9...
... • The 1970 Developmental Disabilities Services and Facilities Con struction Amendments Act had the effect of building better institu tions and facilities for people with developmental disabilities. Yee noted that one law in particular, the Developmental Disabilities Assistance and Bill of Rights Act of 1975, represented a leap in acknowledging
From page 10...
... "Many people in the disability community have been fighting for years to overcome that, to try to rebalance how money is spent in the Medicaid system," said Yee, who added that the law is slowly evolving toward that type of rebalancing. Federal oversight, monitoring, and implementation, versus federal deferral to state flexibility, has increased with the advent of civil rights laws, such as the 1973 Rehabilitation Act and the 1990 Americans with Disabilities Act (ADA)
From page 11...
... She added that existing nondiscrimination laws are poor tools for forcing systemic change in such critical areas as provider training, interagency coordination, and intersectional data collection. Accessing long-term services and supports is critical for the well-being of people with chronic disabilities, as is care coordination among physical and mental health care providers and between medical care and the providers of long-term services and supports, said Yee.
From page 12...
... She also remarked on the slow recognition of the need for physical and programmatic accessibility7 in managed care and provider network adequacy, a topic that subsequent speakers would address. Yee concluded her talk by listing the following key recommendations in the commissioned paper accompanying this Proceedings of a Workshop: • Improve data collection by mandating the use of the six HHS disability questions in relevant population surveys and electronic health records (EHRs)
From page 13...
... • Reform health care financing to include risk adjustment for socio economic status in payment and in quality reporting. • CMS should strengthen Medicaid managed care provider network adequacy standards by requiring a showing of accessibility and ca pacity to accommodate and by calling for networks to be expanded if found to be deficient.
From page 14...
... TRANSLATING COVERAGE INTO HEALTH EQUITY: THE ROLE OF HEALTH LITERACY IN HEALTHY LIVING9 Community Catalyst is a national consumer health advocacy organization that supports consumer health advocates and their community partners in about 40 states. Its efforts are designed to ensure that all people have equal access to high-quality health care.
From page 15...
... Community Catalyst is also supporting a project in Missouri using health literacy tools outside of the health care system to ensure that individuals in an addiction recovery program who are exiting the criminal justice system -- many of whom have chronic health conditions -- have access to the tools to help them succeed when they reenter the community. In Rhode Island, the Rhode Island Parent Information Network is leveraging the community health worker in a peer-learning model to help persons of color who have disabilities engage in primary care.13 Palacios then discussed new evidence-based self-management programs 10  See http://fcsn.org (accessed October 10, 2017)
From page 16...
... Through these programs, which were developed at the Stanford University Patient Education Research Center and are integrated within the health care delivery system, participants obtain knowledge about the processes involved in accessing care and the services they need to make appropriate health decisions, increasing their health literacy as they go through the program and becoming empowered individual advocates. These programs are being implemented in diverse community settings within the health care delivery system; for example, in medical homes, ac
From page 17...
... Patients, they report, are more empowered to play a role in their own care, are better able to manage their medications and advocate in a proactive way with their care managers, and work more effectively with community health workers. At the system level, patients report being more satisfied with their health care based on the Healthcare Effectiveness Data and Information Set (HEDIS)
From page 18...
... 18 TABLE 2-1  Vulnerable Populations Targeted by Community Catalyst's Projects Change from Year 1 Year 2 Year 3 Total National Year 1–3 Participants 1,612 2,487 2,506 6,605 -- 55.46% Completers 1,235 1,932 1,917 5,084 -- 55.22% Completion Rate 76.60% 77.70% 76.60% 77.00% 73.20% 0.00% Native American 3.40% 1.10% 1.40% 1.97% 2.30% −58.82% Asian 10.20% 3.60% 8.50% 7.43% 4.20% −16.67% Black 6.60% 13.30% 18.20% 12.70% 22.20% 175.76% Latino 9.40% 16.80% 22.70% 16.30% 17.10% 141.49% Caregiver 16.30% 22.00% 29.10% 22.47% 29.20% 78.53% Disability 50.50% 48.10% 53.10% 50.57% 45.00% 5.15% SOURCE: Stahl and Palacios slide 19 (previously unpublished data)
From page 19...
... Instead, the law creates a framework for how to approach a person with a disability and requires providers, hospitals, and other health care professionals in a health care system to talk with those with disabilities to figure out what they need and how to accommodate that need. Individuals with disabilities, except perhaps those with newly acquired disabilities, know very well what they need to live life to the fullest and obtain appropriate health care.
From page 20...
... Jennifer Dillaha from the Arkansas Department of Health voiced her support for the notion of shifting disability from being a health outcome to a demographic feature, but she wondered how effectively EHRs were capturing disability. Yee said that such information is not routinely collected in EHRs and that she and her colleagues have been working with the Consumer Partnership for eHealth to advocate for including the six HHS questions in EHRs (see the questions listed earlier in this chapter)
From page 21...
... Rose Marie Martinez from the National Academies' Health and Medicine Division replied that disabilities were not included in that report. Francisco García from the Pima County Health Department in Arizona said he finds the concept of using the accreditation process as a means of ensuring that people can take action on the rights that various laws bestow on them intriguing.
From page 22...
... Yee recounted that the Joint Commission developed some guidelines around disabilities several years ago, but she did not believe that there is a requirement to provide accommodations for those with disabilities in order to receive accreditation. The lack of connection between federal laws, disability civil rights, and the bodies that certify providers, hospitals, and various health care entities needs to be addressed, said Yee.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.