Elizabeth K. Rasch

The Supported Employment Demonstration (SED) offered vocational and mental health services to recently denied disability benefit applicants with mental health conditions, along with other multiple co-morbidities, to evaluate the impact of evidence-based interventions on fostering employment and downstream benefits such as self-sufficiency, improved quality of life, and improved mental health. Using the SED public use file, we analyzed work outcomes for the study participants in relation to functional improvement, as measured by the Work Disability Functional Assessment Battery, vs. medical improvement. Using both Bayesian logistic regression models and neural networks, we found that functional improvement is a better predictor of steady work than medical improvement.

Background Returning to work benefits many people with disabilities, as it supports personal financial independence and provides opportunities for greater societal contributions. The U.S. Social Security Administration’s Ticket to Work (TTW) program offers expanded support services to help disability beneficiaries achieve financial independence through gainful employment. SSA has continuously sought new ways to identify those who would most benefit from using a Ticket. Objective To identify factors contributing to TTW participation and assess its impact on benefits forgone for work. Methods We conducted a cohort study using SSA administrative data to predict TTW participation and its impact on benefit cessation. The study sample included beneficiaries with a physical or mental residual functional capacity assessment from 2016. We applied a frequentist propensity score matching estimate and a doubly robust Bayesian hierarchical model-based estimate. Results The study included 172,640 beneficiaries (52.7% male, average age 52 years) with a range of qualifying conditions: musculoskeletal disorders (45.04%), mental disorders (29.10%), neurological disorders (9.82%). Both analytic methods yielded consistent results, showing that TTW participation is effective even after controlling for confounding factors. Personal characteristics (e.g., sex, age, education, race/ethnicity), health and functional status (e.g., work cessation due to health issues, need for alternate sitting arrangements, and limitations in understanding and memory) and environmental factors (e.g., region of residence) influenced Ticket participation. Conclusions Our findings offer valuable insights for identifying potential TTW participants and estimating benefit savings for SSDI/SSI programs. Future research should explore available support services and barriers to access to improve TTW outcomes.

The Supported Employment Demonstration (SED) offered vocational and mental health services to recently denied disability benefit applicants with mental health conditions, along with other multiple co-morbidities, to evaluate the impact of evidence-based interventions on fostering employment and downstream benefits such as self-sufficiency, improved quality of life, and improved mental health. Using the SED public use file, we analyzed work outcomes for the study participants in relation to functional improvement, as measured by the Work Disability Functional Assessment Battery, vs. medical improvement. Using both Bayesian logistic regression models and neural networks, we found that functional improvement is a better predictor of steady work than medical improvement.

Introduction Many Americans fail to receive equitable access to or positive outcomes from rehabilitation services. These disparities result from broader societal inequities that disproportionately affect certain groups of people due to non-medical factors such as race, gender, education and living status. This scoping review aims to describe research papers that examine social determinants of health (SDOH) that underlie disparities in access to, use of, or outcomes related to rehabilitation (in occupational therapy, physical therapy, recreational therapy, rehabilitation medicine/physiatry and speech-language pathology) among adults in the USA. Identifying SDOH-related factors that drive inequities in rehabilitation will inform the development of potential solutions to improve access, professional education and patient outcomes. Methods and analysis The Joanna Briggs Institute methodological framework will be used to conduct this scoping review. To meet the inclusion criteria, articles will need to be published in English since 2013, be classified as full-length original research, include at least 100 sampled adults, be conducted in the USA or its territories, and investigate SDOH-related disparities in rehabilitation. Search terms will include SDOH, rehabilitation and disparities. Five databases (Embase, PubMed, Scopus, Sociological Abstracts and Web of Science: Core Collection) will be searched for articles published in English between 2013 and 2023. Records from these databases as well as reference lists of included papers and review papers will be screened for eligibility. Two people will independently review each record during title and abstract screening and full-text screening, and three people will independently extract data. Screening and data extraction processes will be piloted. The results will be presented in tables, graphs and narrative summaries. Ethics and dissemination Findings will be disseminated through scientific conferences, professional networks, stakeholder meetings, invited workshops and webinars, email listservs of professional associations, academic social media and in a peer-reviewed journal. Ethics approval is not required as the review will only include previously published data.

Background: Human activity and the interaction between health conditions and activity is a critical part of understanding the overall function of individuals. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) models function as all aspects of an individual’s interaction with the world, including organismal concepts such as individual body structures, functions, and pathologies, as well as the outcomes of the individual’s interaction with their environment, referred to as activity and participation. Function, particularly activity and participation outcomes, is an important indicator of health at both the level of an individual and the population level, as it is highly correlated with quality of life and a critical component of identifying resource needs. Since it reflects the cumulative impact of health conditions on individuals and is not disease specific, its use as a health indicator helps to address major barriers to holistic, patient-centered care that result from multiple, and often competing, disease specific interventions. While the need for better information on function has been widely endorsed, this has not translated into its routine incorporation into modern health systems.Purpose: We present the importance of capturing information on activity as a core component of modern health systems and identify specific steps and analytic methods that can be used to make it more available to utilize in improving patient care. We identify challenges in the use of activity and participation information, such as a lack of consistent documentation and diversity of data specificity and representation across providers, health systems, and national surveys. We describe how activity and participation information can be more effectively captured, and how health informatics methodologies, including natural language processing (NLP), can enable automatically locating, extracting, and organizing this information on a large scale, supporting standardization and utilization with minimal additional provider burden. We examine the analytic requirements and potential challenges of capturing this information with informatics, and describe how data-driven techniques can combine with common standards and documentation practices to make activity and participation information standardized and accessible for improving patient care.Recommendations: We recommend four specific actions to improve the capture and analysis of activity and participation information throughout the continuum of care: (1) make activity and participation annotation standards and datasets available to the broader research community; (2) define common research problems in automatically processing activity and participation information; (3) develop robust, machine-readable ontologies for function that describe the components of activity and participation information and their relationships; and (4) establish standards for how and when to document activity and participation status during clinical encounters. We further provide specific short-term goals to make significant progress in each of these areas within a reasonable time frame.

Background: Given the complexity of the adjudication process and volume of applications to Social Security Administration’s (SSA) disability programs, many individuals with serious medical conditions die while awaiting an application decision. Limitations of traditional survival methods called for a new empirical approach to identify conditions resulting in rapid mortality. Objective: To identify health conditions associated with significantly higher mortality than a key reference group among applicants for SSA disability programs. Research Design: We identified mortality patterns and generated a survival surface for a reference group using conditions already designated for expedited processing. We identified conditions associated with significantly higher mortality than the reference group and prioritized them by the expected likelihood of death during the adjudication process. Subjects: Administrative records of 29 million Social Security disability applicants, who applied for benefits from 1996 to 2007, were analyzed. Measures: We computed survival spells from time of onset of disability to death, and from date of application to death. Survival data were organized by entry cohort. Results: In our sample, we observed that approximately 42,000 applicants died before a decision was made on their disability claims. We identified 24 conditions with survival profiles comparable with the reference group. Applicants with these conditions were not likely to survive adjudication. Conclusions: Our approach facilitates ongoing revision of the conditions SSA designates for expedited awards and has applicability to other programs where survival profiles are a consideration.

Objective: To examine the relationship between emergency department (ED) use and access to medical care and prescription medications among working ageAmericans with disabilities.Data Source: Pooled data from the 2006–2008 Medical Expenditure Panel Survey (MEPS), a U.S. health survey representative of community‐dwelling civilians.Study Design: We compared the health and service utilization of two groups of people with disabilities to a contrast group without disability. We modeledEDvisits on the basis of disability status, measures of health and health conditions, access to care, and sociodemographics.Data Extraction: These variables were aggregated from the household component, the medical condition, and event files to provide average annual estimates for the period spanning 2006–2008.Principal Findings: People with disabilities accounted for almost 40 percent of the annual visits made to U.S.EDs each year. Three key factors affect theirEDuse: access to regular medical care (including prescription medications), disability status, and the complexity of individuals’ health profiles.Conclusions: Given the volume of health conditions among people with disabilities, theEDwill always play a role in their care. However, someEDvisits could potentially be avoided if ongoing care were optimized.

Background and Purpose—: Our objective was to examine the agreement between adult patients with stroke and family member or clinician proxies in activity measure for postacute care (AM-PAC) summary scores for daily activity, basic mobility, and applied cognitive function. Methods—: This study involved 67 patients with stroke admitted to a hospital within the Kaiser Permanente of Northern California system and were participants in a parent study on stroke outcomes. Each participant and proxy respondent completed the AM-PAC by personal or telephone interview at the point of hospital discharge or during ≥1 transitions to different postacute care settings. Results—: The results suggest that for patients with a stroke proxy, AM-PAC data are robust for family or clinician proxy assessment of basic mobility function and clinician proxy assessment of daily activity function, but less robust for family proxy assessment of daily activity function and for all proxy groups' assessments of applied cognitive function. The pattern of disagreement between patient and proxy was, on average, relatively small and random. There was little evidence of systematic bias between proxy and patient reports of their functional status. The degree of concordance between patient and proxy was similar for those with moderate to severe strokes compared with mild strokes. Conclusions—: Patient and proxy ratings on the AM-PAC achieved adequate agreement for use in stroke research when using proxy respondents could reduce sample selection bias. The AM-PAC data can be implemented across institutional as well as community care settings while achieving precision and reducing respondent burden.