Brief Report Prevalence of Preventive Measures in Selected Disabilities versus a Matched Comparator
by Yuancheng Wei, Nicholas Orfan*, Thomas Wilson
Population Health Impact Institute, USA
*Corresponding author: Nicholas Orfan, Population Health Impact Institute, USA
Received Date: 07 January, 2024
Accepted Date: 11 January, 2024
Published Date: 15 January, 2024
Citation: Wei Y, Orfan N, Wilson T (2024) Prevalence of Preventive Measures in Selected Disabilities versus a Matched Comparator. J Family Med Prim Care Open Acc 8: 246. https://doi.org/10.29011/2688-7460.100246
Background
A substantial literature exists examining access to preventive health services for those with physical or intellectual disabilities versus the non- disabled [1]. We used a large all payer claims data set to explore this question.
Methods
The data accessed was from the Colorado All Payer Claims Database with dates of service from 1/1/2017 to 6/30/2020. Based on CMS guidelines for disabling conditions, we identified patients with ICD10 codes for the following conditions: cerebral palsy, cystic fibrosis, mobility impairment, multiple sclerosis, muscular dystrophy, spina bifida, traumatic brain injury.
CPT codes specifying 4 non gender specific preventive healthcare procedures of varying degrees of mechanical performance difficulty (levels 1-4) were selected as follows: level 1-alcohol misuse screening and consulting, level 2-pneumococcal vaccine, level 3-cholesterol screening, level 4 - colorectal cancer screen.
After identifying the disabled population, we used propensity score matching to select non-disabled comparators on a 1:1 basis and then compared the prevalence of the 4 chosen preventive healthcare CPT codes (at least one claim during the dates of service interval) between the disabled versus non-disabled cohort.
Results
The major finding was that those with disabling conditions have a higher percentage of the Level 1 (alcohol misuse screening and consulting) and Level II (pneumococcal immunization) preventive procedures than a matched reference group. This finding was largely true of Level 3 (cholesterol screening) with the exception of muscular dystrophy and spinal cord injury. With Level IV (colonoscopy), we more often saw a lower rate of preventive screening in the disabled population: CRC screening rates were lower in CP, MI, MS, SCI and TBI.
|
Disability Description |
N |
Level I Survey Type |
Level II Vaccination |
Level III Blood Draw Type |
Level IV Physical Exam Type |
|
Alcohol Misuse Screening and Consulting |
Pneumococcal vaccine |
Cholesterol screening |
Colo-rectal cancer screening |
||
|
Cerebral Palsy (CP) |
7,320 |
0.5% |
9.6% |
38.0% |
1.0% |
|
CP comparator |
7,320 |
0.1% |
6.1% |
34.7% |
1.4% |
|
Difference |
0.4% |
3.4% |
3.3% |
-0.4% |
|
|
% Difference |
75.0% |
35.7% |
8.6% |
-42.9% |
|
|
Cystic Fibrosis (CF) |
19,320 |
1.7% |
11.0% |
66.1% |
2.6% |
|
CF comparator |
19,320 |
0.5% |
10.8% |
48.3% |
2.6% |
|
Difference |
1.2% |
0.2% |
17.8% |
0.1% |
|
|
% Difference |
72.7% |
1.9% |
26.9% |
2.0% |
|
|
Mobility Impairment (MI) |
29,090 |
1.3% |
17.5% |
56.1% |
2.1% |
|
MI comparator |
29,090 |
1.0% |
14.4% |
56.1% |
3.5% |
|
Difference |
0.3% |
3.1% |
0.0% |
-1.4% |
|
|
% Difference |
21.6% |
17.5% |
0.0% |
-68.9% |
|
|
Multiple Sclerosis (MS) |
14,140 |
0.6% |
14.6% |
57.9% |
3.5% |
|
MS comparator |
14,140 |
0.6% |
9.2% |
56.3% |
3.6% |
|
Difference |
0.1% |
5.4% |
1.6% |
-0.1% |
|
|
% Difference |
11.1% |
36.9% |
2.7% |
-2.0% |
|
|
Muscular Dystrophy (MD) |
1,100 |
0.0% |
10.9% |
33.6% |
1.8% |
|
MD comparator |
1,100 |
0.0% |
6.4% |
38.2% |
0.9% |
|
Difference |
0.0% |
4.5% |
-4.5% |
0.9% |
|
|
% Difference |
NA |
41.7% |
-13.5% |
50.0% |
|
|
Spina Bifida (SB) |
10,140 |
0.3% |
13.5% |
34.2% |
1.5% |
|
SB comparator |
10,140 |
0.2% |
12.1% |
29.3% |
1.0% |
|
Difference |
0.1% |
1.4% |
4.9% |
0.5% |
|
|
% Difference |
33.3% |
10.2% |
14.4% |
33.3% |
|
|
Spinal Cord Injury (SCI) |
17,580 |
1.2% |
14.9% |
51.5% |
2.6% |
|
SCI comparator |
17,580 |
0.7% |
12.2% |
52.3% |
3.2% |
|
Difference |
0.5% |
2.7% |
-0.8% |
-0.6% |
|
|
% Difference |
38.1% |
18.3% |
-1.5% |
-24.4% |
|
|
Traumatic Brain Injury (TBI) |
24,370 |
0.7% |
9.8% |
50.1% |
2.1% |
|
TBI comparator |
24,370 |
0.2% |
7.3% |
44.0% |
2.5% |
|
Difference |
0.5% |
2.4% |
6.2% |
-0.5% |
|
|
% Difference |
72.2% |
24.8% |
12.3% |
-24.0% |
|
|
Legend |
Significantly lower in disabled population |
||||
|
Amount lower (n and %) in disabled population vs. age-sex matched comparator |
|||||
Significance
We conclude that easily performed preventive measures are conducted at a higher rate in the disabled population than a matched group. We also observed that this finding is reversed with the more mechanically difficult (level 4) CRC screening. Clinicians should be aware of this pattern and make an effort to mitigate it.
References
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