Health-Care Utilization as a Proxy in Disability Determination (2018) / Chapter Skim
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4 Health-Care Utilizations as Proxies for Listing-Level Severity
4 Health-Care Utilizations as Proxies for Listing-Level Severity
Pages 57-88
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From page 57... ...
SSA defines a severe impairment as one that "significantly limits an individual's physical or mental abilities to do basic work activities" (SSR 96-3p) ; according to the committee's statement of task, "listing-level" severity refers to an impairment that is "severe enough to prevent a person from doing any gainful activity." SSA defines disability as "the inability to engage in any substantial gainful activity (SGA)
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From page 58... ...
or continuous (i.e., degrees of motion lost) criteria." According to AMA's definition, severity of impairment is closely related to disease severity but distinct from disability, which is defined as "activity limitations and/or participation restrictions in an individual with a health condition, disorder, or disease." This distinction can be contrasted with how SSA defines both impairment severity and disability in terms of activity limitations.
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From page 59... ...
ED and inpatient data are weighted national estimates of data from 2014. The committee chose to include patients 18–64 years old inasmuch as most adults who receive disability insurance are in this age range.
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Rheumatoid arthritis 18–44 1,875 40,690 11,121 113,475 45–64 4,245 174,350 15,920 261,284 Chronic obstructive pulmonary 18–44 15,055 123,105 428,054 800,494 disease 45–64 207,510 1,334,910 716,674 2,566,250 Asthma 18–44 57,365 525,900 672,021 3,207,651 45–64 101,810 846,255 415,384 1,992,940 Congestive heart failure, 18–44 36,205 154,510 46,064 258,956 nonhypertensive 45–64 216,960 1,049,790 250,728 1,372,318 Hypertension with complications 18–44 37,920 259,940 57,126 378,421 and secondary hypertension 45–64 91,585 1,135,015 126,697 1,334,815 Gastritis and duodenitis 18–44 18,900 105,370 313,802 527,001 45–64 28,050 214,675 146,079 388,181 Diverticulosis and diverticulitis 18–44 36,980 62,355 86,577 159,510 45–64 108,245 268,125 196,719 455,097 Chronic renal failure 18–44 5,025 265,170 15,807 425,281 45–64 7,840 1,113,365 26,476 1,363,201 Diabetes mellitus without 18–44 3,370 408,830 127,544 2,020,023 complication 45–64 3,940 1,864,901 154,277 4,888,412 Diabetes mellitus with 18–44 166,095 346,030 252,650 519,229 complications 45–64 208,550 1,014,680 319,224 1,201,715
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From page 61... ...
TABLE 4-2 Hospitalizations and Emergency Department Visits of People 18–44 Years Old for Selected Health Conditions in the United States in 2014 Rheumatoid Congestive Schizophrenia Arthritis and Heart Failure, and Other Chronic Related Nonhyper- Psychotic Renal ALS Asthma COPD Conditions tensive Disorders Failure CCS category ICD 128 127 202 108 659 158 335.2 Hospital stays No. hospital 170 57,365 15,055 1,875.0 36,205 197,675 7,840 stays No.
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, and about 8 percent had asthma. TABLE 4-3 Hospitalizations and Emergency Department Visits of People 45–64 Years Old for Selected Health Conditions in the United States in 2014 Rheumatoid Congestive Schizophrenia Arthritis Heart Failure, and Other Chronic and Related Nonhyper- Psychotic Renal ALS Asthma COPD Conditions tensive Disorders Failure CCS category ICD 128 127 202 108 659 158 335.2 Hospital stays No.
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From page 63... ...
, sorting by CCS codes, and stratifying by age group. ED data are weighted national estimates from the HCUP National Emergency Department Sample, 2014, with an undefined population sample size; inpatient data are weighted national estimates from the HCUP National Inpatient Sample, 2014, N = 35,358,818.
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From page 64... ...
Health-care utilizations alone are not shown to predict disease severity or disability, and other factors arose as predictive. Health-care utilizations are found to increase for nonclinical reasons not related to severity of injury or impairment, and these nonclinical factors might also drive down health-care utilization.
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From page 65... ...
, inability to find gainful employment, terminal disease, multiple hospitalizations in a year, severe frequent exacerbations of oxygen supplementation, or ventilator assistance mark greater severity and possible disability. Respiratory disorders accounted for 2.6 percent of diagnoses of disability insurance beneficiaries in 2014 (SSA, 2015)
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accounted for 7.5 percent of diagnoses of disability insurance beneficiaries in 2014 (SSA, 2015) .The most common impairing CVDs -- excluding stroke -- involve coronary heart disease, heart failure (HF)
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DIGESTIVE SYSTEM Digestive diseases accounted for 1.5 percent of diagnoses of disability insurance beneficiaries in 2014 (SSA, 2015)
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In addition to diseasespecific characteristics, the presence of psychiatric disorders, sleep disturbance, and multiple somatic comorbidities is associated with a greater risk of disability in patients who have gastrointestinal diagnoses. GENITOURINARY DISORDERS Genitourinary diseases accounted for 1.6 percent of diagnoses of disability insurance beneficiaries in 2014.
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, fewer studies have examined this comorbidity as a predictor of longer-term outcomes. HEMATOLOGIC DISORDERS Hematologic diseases accounted for 0.3 percent of diagnoses of disability insurance beneficiaries in 2014 (SSA, 2015)
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. ENDOCRINE DISORDERS Endocrine diseases accounted for 0.3 percent of diagnoses of disability insurance beneficiaries in 2014.
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From page 71... ...
The committee's search on the use of health-care utilizations as indicators of impairment did not yield any articles related to congenital disorders that affect multiple body systems as defined by SSA. NEUROLOGIC DISORDERS Neurologic conditions accounted for 9.4 percent of diagnoses of disability insurance beneficiaries in 2014.
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From page 72... ...
Finally, the committee gives an example of a prescription drug whose use could indicate impairment severity; this example is based on the committee's expert opinion, not on evidence found in the literature. Comorbid Mental Disorders In patients who had heart failure or other cardiac diseases, comorbid depression and anxiety were found to increase health-services utilization in a prospective study of 402 patients (Moraska et al., 2013)
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From page 73... ...
. Comorbid serious mental illness was suggested to lead to increased risk of repeat hospitalization in general medical patients in a longitudinal cohort study of 925,705 adults in Washington state (Daratha et al., 2012)
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The majority of the literature that the committee reviewed concluded that comorbid mental disorders can indicate disease severity in people who present with other diseases. That could be because people who have comorbid mental disorders are especially vulnerable to the consequences of disease and might have more difficulty in accessing healthcare services.
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The committee found several studies that suggested an association between utilization and disease severity in people who had HIV/AIDS or SLE. The studies suggest that frequency of ED visits might reflect disease severity in patients who have SLE (Panopalis et al., 2010)
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, and that frequency of outpatient-clinic use might reflect disease severity in HIV patients (Palma et al., 2015)
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noted that neither mode of dialysis, length of time on dialysis, number of comorbid conditions, nor cause of renal failure was associated with employment status. Functional status was positively associated with employment.
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In particular, psychiatric disorders were found to increase the likelihood of disability associated with and use of healthcare services to address medical conditions of several body systems. Most of the literature found on mental disorders was related to their use as comorbid conditions that can predict increased resource utilization by, greater disability of, and greater length of hospital stay of patients who have various health conditions.
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From page 79... ...
However, they are not informative with respect to whether these utilizations are useful for indicating disease severity or inability to work. Little research has attempted to account for the relationships among employment, health, and disability.
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2012. Factors associated with hospital admission for exacerbation of chronic obstructive pulmonary disease.
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2017a. Chronic obstructive pulmonary disease (COPD)
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2008. Hospital admission rates among men and women with symptoms of chronic bronchitis and airflow limitation corresponding to the gold stages of chronic obstructive pulmonary disease -- a population-based study.
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2008. Race and the natural history of chronic heart failure: A propensity-matched study.
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2013. Depression, healthcare utilization, and death in heart failure: A community study.
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Journal of Chronic Obstructive Pulmonary Disease 5(6)
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2002. The impact of chronic obstructive pulmonary disease on work loss in the United States.
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2014. Worsening of renal function during 1 year after hospital discharge is a strong and independent predictor of all-cause mortality in acute decompensated heart failure.
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