A call to action: Preparing a disability-competent health care workforce.

People with disabilities make up the largest minority population in the country, yet our health care workforce is unprepared to meet their needs. Two initiatives - and the Alliance for Disability in Health Care Education's Disability Competencies and the Resources for Integrated Care Disability-Competent Care model-provide essential tools to build a health care workforce prepared to meet the health needs of people with disabilities. We note gaps in health education and continuing education curricula, document barriers to progress, and demonstrate how the two initiatives offer a clear roadmap to effect systemic change. Finally, we issue a call to action for health care education, practice, and research to ensure a health care workforce prepared to provide quality health care to people with disabilities.

Determinants of neurological disease: Synthesis of systematic reviews.

Systematic reviews were conducted to identify risk factors associated with the onset and progression of 14 neurological conditions, prioritized as a component of the National Population Health Study of Neurological Conditions. These systematic reviews provided a basis for evaluating the weight of evidence of evidence for risk factors for the onset and progression of the 14 individual neurological conditions considered. A number of risk factors associated with an increased risk of onset for more than one condition, including exposure to pesticides (associated with an increased risk of AD, amyotrophic lateral sclerosis, brain tumours, and PD; smoking (AD, MS); and infection (MS, Tourette syndrome). Coffee and tea intake was associated with a decreased risk of onset of both dystonia and PD. Further understanding of the etiology of priority neurological conditions will be helpful in focusing future research initiatives and in the development of interventions to reduce the burden associated with neurological conditions in Canada and internationally.

A systematic review of the risks factors associated with the onset and natural progression of hydrocephalus.

The purpose of this study was to systematically assess and synthesize the world literature on risk factors for the onset and natural progression of hydrocephalus, thereby providing a basis for policy makers to identify appropriate risk management measures to mitigate the burden of disease in Canada. Evidence for risk factors was limited for both onset and progression. Two meta-analyses that examined a risk factor for onset met the inclusion criteria. One found a significant protective effect of prenatal vitamins among case control studies, but not cohort/randomized controlled trials (RCTs). The second found maternal obesity to be a significant risk factor for congenital hydrocephalus. Significant risk factors among 25 observational studies included: biological (multiple births, maternal parity, common cold with fever, maternal thyroid disease, family history, preterm birth, hypertension, ischemic heart disease, ischemic ECG changes, higher cerebrospinal fluid protein concentration following vestibular schwannoma); lifestyle (maternal obesity, high-density lipoprotein (HDL) cholesterol, maternal diabetes, maternal age), healthcare-related (caesarean section, interhospital transfer, drainage duration following subarachnoid hemorrhage, proximity to midline for craniectomy following traumatic brain injury); pharmaceutical (prenatal exposure to: tribenoside, metronidazole, anesthesia, opioids); and environmental (altitude, paternal occupation). Three studies reported on genetic risk factors: no significant associations were found. There are major gaps in the literature with respect to risk factors for the natural progression of hydrocephalus. Only two observational studies were included and three factors reported. Many risk factors for the onset of hydrocephalus have been studied; for most, evidence remains limited or inconclusive. More work is needed to confirm any causal associations and better inform policy.

Multiple chronic medical conditions and health-related quality of life in older adults, 2004-2006.

INTRODUCTION: Understanding longitudinal relationships among multiple chronic conditions, limitations in activities of daily living, and health-related quality of life is important for identifying potential opportunities for health promotion and disease prevention among older adults. METHODS: This study assessed longitudinal associations between multiple chronic conditions and limitations in activities of daily living on health-related quality of life among older adults (≥65 years) from 2004 through 2006, using data from the Medicare Health Outcomes Survey (N = 27,334). RESULTS: Using a longitudinal path model, we found the numbers of chronic conditions at baseline and 2-year follow-up were independently associated with more limitations in activities of daily living at 2-year follow-up. In addition, more limitations in activities of daily living at 2-year follow-up were associated with worse health-related quality of life during the follow-up time period. The association between multiple chronic conditions and indices of health-related quality of life was mediated by changes in limitations in activities of daily living. CONCLUSION: Both baseline and new multiple chronic conditions led to worse health in terms of activities of daily living and health-related quality of life and should be considered important outcomes to intervene on for improved long-term health. In addition, public health practitioners should consider addressing classes of multiple chronic conditions by using interventions designed to reduce the emergence of multiple chronic conditions, such as physical activity, reductions in smoking rates, and improved and coordinated access to health care services.

Evaluating outcomes of care and targeting quality improvement using Medicare health outcomes survey data.

The Medicare Health Outcomes Survey (HOS) provides a rich source of outcomes data on the Medicare Advantage (MA) program for the US Department of Health and Human Services, managed care organizations participating in Medicare, quality improvement organizations, and health services researchers working to improve quality of care for Medicare enrollees. Since 1998, the Centers for Medicare and Medicaid Services has collected longitudinal functional status information to assess the performance of Medicare managed care organizations. This introduction reviews the goals of the HOS program, how the HOS supports health care reform, and outlines recent HOS studies exploring data applications for monitoring outcomes and implementing quality improvement activities.

Understanding and improving psychosocial services in long-term care.

In this issue of the Health Care Financing Review, we present research that speaks to the importance of psychosocial care and its relationship to the overall well-being and quality of life for people receiving long-term care (LTC) services in nursing homes and community-based settings. The articles address numerous psychosocial processes of care and outcomes within the LTC service spectrum. This overview discusses the rationale for examining psychosocial services in the context of quality of life in LTC; summarizes the focus of the articles in this issue; and highlights current CMS initiatives relevant to psychosocial needs in LTC including national data sources that measure psychosocial services and outcomes of care and can be used to develop programs to improve care and outcomes.

Measuring and improving health outcomes in Medicare: the Medicare HOS program.

The Medicare Health Outcomes Survey (HOS) (originally called the Health of Seniors Survey) was developed as a longitudinal performance measure to assess the physical functioning and mental well being of Medicare beneficiaries over time. The survey was implemented nationally in Medicare managed care organizations (MCOs) as part of Medicare HEDIS, 3.0/1998 and continues today. In 1998, a pilot test of the HOS in Medicare FFS was conducted; the pilot test concluded in 2001. This overview discusses the importance of functional status assessment, reviews the goals of the HOS, and explains how researchers and quality improvement professionals are using the data to explore functional status measurement issues, describe policy and programmatic implications for CMS, and identify opportunities to improve health care practice.