Declining high-impact clinical publication rate: A potential contributor to health disparities among persons with developmental and intellectual disabilities.

Background: Persons with intellectual and developmental disabilities (IDD) suffer from stark, well-documented health and healthcare disparities, despite data indicating that the majority see a healthcare provider at least annually. Multiple surveys have indicated that over 90% of physicians feel they have inadequate knowledge and skill in caring for those with IDD. This has been recognized as a key barrier to health equity. Objective: To evaluate the content of high-impact clinical literature for a potential cause of clinician knowledge deficits. Methods: We performed a bibliometric analysis of publications within major, high-impact general, and specialty clinical journals from 1946 to 2020 to determine the relative frequency of publications regarding IDD and publication rate. Results: We observed a significant decline in articles regarding IDD over the past 20 years within high-impact general medical journals, and a significant decline over the past 15 years within high-impact, specialty society-published journals of Psychiatry, Psychology, and Neurology. Furthermore, we observed that high-impact general medical journals devoted a significantly smaller proportion of publication space to articles regarding IDD than they did for conditions with similar prevalence such as HIV/AIDS, breast cancer, and drug abuse. Conclusion: The declining rate and low frequency of clinical publications regarding IDD within the major, respected clinical literature may be contributing to physicians' ability to source evidence-based information, thereby impacting perceptions of skill and knowledge deficits, and therefore may be contributing to healthcare disparities in this population. Well-designed clinical studies that engage persons with IDD may lead to an evidence base within the clinical literature that will improve physician confidence and care quality.

Roadmap for Creating Effective Communication Tools to Improve Health Equity for Persons With Intellectual and Developmental Disabilities.

Persons with intellectual and developmental disabilities (IDD) live 20 fewer years than the average person and almost 40% of their deaths are from preventable causes. They suffer from well-documented disparities in health and healthcare, and much of this inequity is rooted in information transfer failures between patients, their caregivers, and their healthcare providers. Tools to improve communication between these stakeholders, such as health checks and hand-held health records, or health passports, have been implemented in Europe, Australia and Canada with mixed results, and there are no standard information tools currently in widespread use in the U.S. We review the evidence of the effectiveness of these tools, as well as their barriers to adoption, to inform proposed development of next-generation information transfer tools most useful to patients with IDD and their healthcare providers. The repair of health information transfer failures will be a major step toward achieving health equity for this population.

What have we learned about how to measure quality of care for patients with community-acquired pneumonia?

The most commonly used measures of quality of care for hospitalized pneumonia patients are process measures as opposed to outcome measures.For a process measure to be useful in assessing quality of care, it must be linked to a desired outcome. For patients hospitalized with pneumonia, the obtaining of blood cultures, the timely use of appropriate antibiotics, and the delivery of the influenza and pneumococcal vaccines are the process measures most widely used for assessing quality of care in relation to clinical outcomes. The admission decision and the length of time that intravenous antibiotics are used are process measurements that directly affect financial outcomes.