Disability Surveillance using NationalHousehold Surveys in the UnitedStates: Where have we been andwhere are we going?Eric...
Introduction• Focus– The difficulties of defining disability. The conceptthat disability is a state of being rather than a...
Overview• Challenges for evaluating data• Health & Disability Models• National Survey Methodology• Survey Administration• ...
Challenges• What is the relationship between health anddisability?– Distinct yet overlapping constructs– Function & Functi...
Health & Disability ModelMolla, M.T., J. H. Madans, D. K. Wagener, and E. M. Crimmins. "Summary Measures ofPopulation Heal...
International Classification ofFunctioning: Domains
ICF Applied
Challenges, cont.• How do you evaluate the data collected?– Consider the historical context– Consider the implications of ...
Survey Method Overview
Challenges, continued• Most importantly, how do we moveforward???– Example, Cognitive Limitation & MEPS– Acknowledged mode...
Model GapsThere are several concepts that are missed by models of disability:• Individuals can be perceived as having a di...
Areas of Discussion1.2. 3.4.
Constructs
Constructs, continued.ConstructErrorItemMalhotra & Grover, 1998
Survey Administration
Survey Administration, continued• Sampling Design• Primary Sampling Units• Over- and Under- Sampling• High- and Low- Respo...
Self-Report
Self-Report• What does an individual consider a limitation?• What does an individual consider (un)healthy?• How does an in...
Six Questions• Is this person deaf or do they have serious difficultyhearing?• Is this person blind or do they have seriou...
Six Questions, continuedQuest Age Y/Y Y/N or N/YHearing 5+ 3.0% 3.0%Vision 5+ 1.2% 2.9%Mobility 5+ 5.4% 4.7%Cognitive 5+ 3...
Interpretation
Estimation & Interpretation• Appropriate Hypotheses• Appropriate statistics– Rates versus ratios, multiplicative effects• ...
What is theoverall state ofdisability research?Malhotra & Grover, 1998. Anassessment of survey research inPOM: from constr...
Where do we go from here?Pick up from here…Malhotra & Grover, 1998
ICF-AHRQ Recommended HealthOutcomesButler M, Kane RL, Larson S, Jeffery MM, Grove M. Quality Improvement Measurement of Ou...
What is it we are trying to measure?What matters most?• Should be based on the outcomes of goals of theresearch• Establish...
What is it we are trying to measure?What matters most?Butler M, Kane RL, Larson S, Jeffery MM, Grove M. Quality Improvemen...
Thank you!• Contact InformationEric A. LauerEmail: eric.lauer@unh.eduPhone: 603-862-4320
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Disability Statistics: Using National Surveys in the United States

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Eric Lauer, University of New Hampshire presented on national survey data used for disability surveillance in the United States

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Disability Statistics: Using National Surveys in the United States

  1. 1. Disability Surveillance using NationalHousehold Surveys in the UnitedStates: Where have we been andwhere are we going?Eric A. Lauer, MPH, PhD CandidateInstitute On DisabilityNew Hampshire, USA
  2. 2. Introduction• Focus– The difficulties of defining disability. The conceptthat disability is a state of being rather than adiagnosis.– There are unintended consequences ofmeasurement. We lose people in the nationalsurveillance model in the United States.
  3. 3. Overview• Challenges for evaluating data• Health & Disability Models• National Survey Methodology• Survey Administration• Introduction of the Six Question Sequence• Self-Reported Limitations• Disability Surveillance in the United States
  4. 4. Challenges• What is the relationship between health anddisability?– Distinct yet overlapping constructs– Function & Functional Limitations
  5. 5. Health & Disability ModelMolla, M.T., J. H. Madans, D. K. Wagener, and E. M. Crimmins. "Summary Measures ofPopulation Health: Report of Findings on Methodologic and Data Issues.". Healthy People2010 (2003).
  6. 6. International Classification ofFunctioning: Domains
  7. 7. ICF Applied
  8. 8. Challenges, cont.• How do you evaluate the data collected?– Consider the historical context– Consider the implications of survey design,sampling design and underlying constructs– Estimating validity, reliability and error– Strengths, weaknesses and limitations of data
  9. 9. Survey Method Overview
  10. 10. Challenges, continued• Most importantly, how do we moveforward???– Example, Cognitive Limitation & MEPS– Acknowledged model gaps– Discuss limitations in an open and transparentmanner
  11. 11. Model GapsThere are several concepts that are missed by models of disability:• Individuals can be perceived as having a disability, or consider themselves to havea disability, but not have this evaluation based on any measurable phenomenon• Disability can only be measured in the context of another domain or area. Somemodels do not take this into account and there is a loss of explanatory power.• The construct of disability is not stable, 5000 people in 5000 different lifecircumstances will have difference rates of disability.• That disability itself, as a distinct phenomenon, independent of any other factor(age or health), changes over time. It may not be constant. Duration of disabilityshould be measured.– There is acute and chronic disability, intermittent, and relatively stable/unstable• Systems that address/explain disability are often not practical enough and do notdirectly inform areas that could be targeted for the alleviation or prevention ofdisability (Ex. poorly defining the concept of the environment)
  12. 12. Areas of Discussion1.2. 3.4.
  13. 13. Constructs
  14. 14. Constructs, continued.ConstructErrorItemMalhotra & Grover, 1998
  15. 15. Survey Administration
  16. 16. Survey Administration, continued• Sampling Design• Primary Sampling Units• Over- and Under- Sampling• High- and Low- Response Regions• Phone, Paper and In-Person Interviewing• Subpopulations missed• Non-response
  17. 17. Self-Report
  18. 18. Self-Report• What does an individual consider a limitation?• What does an individual consider (un)healthy?• How does an individual interpret the actualquestion?• Systematic issues of interpretation, knownand unknown• Proxy Response
  19. 19. Six Questions• Is this person deaf or do they have serious difficultyhearing?• Is this person blind or do they have serious difficultyseeing even when wearing glasses?• Because of a physical, mental or emotional problem,do you have serious difficulty concentrating,remembering or making decisions?• Do you have difficulty walking of climbing stairs?• Do you have difficulty dressing or bathing?• Do you have difficulty doing errands alone such asshopping or visiting a doctor’s office?
  20. 20. Six Questions, continuedQuest Age Y/Y Y/N or N/YHearing 5+ 3.0% 3.0%Vision 5+ 1.2% 2.9%Mobility 5+ 5.4% 4.7%Cognitive 5+ 3.4% 3.9%Self-Care 5+ 1.4% 1.8%Independent 15+ 3.5% 3.5%Any 5+ 10.5% 8.3%
  21. 21. Interpretation
  22. 22. Estimation & Interpretation• Appropriate Hypotheses• Appropriate statistics– Rates versus ratios, multiplicative effects• Confidence Intervals & Standard Errors– Iterative repeated, samples, formulas• Bias– Underlying bias versus biased analysis• Limitations & Generalizability– State versus national data• Weighting• Imputation
  23. 23. What is theoverall state ofdisability research?Malhotra & Grover, 1998. Anassessment of survey research inPOM: from constructs toTheory. Journal of OperationsManagement 16, 407-425.
  24. 24. Where do we go from here?Pick up from here…Malhotra & Grover, 1998
  25. 25. ICF-AHRQ Recommended HealthOutcomesButler M, Kane RL, Larson S, Jeffery MM, Grove M. Quality Improvement Measurement of Outcomes for People With Disabilities. Closingthe Quality Gap: Revisiting the State of the Science. Evidence Report/Technology Assessment No. 208. (Prepared by theMinnesota Evidence-based Practice Center under Contract No. 290-2007-10064-I.) AHRQ Publication No. 12(13)-E013-EF. Rockville, MD:Agency for Healthcare Research and Quality; October 2012. www.effectivehealthcare.gov/reports/final.cfm.
  26. 26. What is it we are trying to measure?What matters most?• Should be based on the outcomes of goals of theresearch• Establish a relationship between the level offocus and outcomes of interest• Distinguish between the following factors:– Interventions directed at a disability from specificinterventions directed at a given medical problem fora person with a disability– Comprehensive programs designed to integratemedical and social services for people withdisabilities.
  27. 27. What is it we are trying to measure?What matters most?Butler M, Kane RL, Larson S, Jeffery MM, Grove M. Quality Improvement Measurement of Outcomes for People With Disabilities. Closingthe Quality Gap: Revisiting the State of the Science. Evidence Report/Technology Assessment No. 208. (Prepared by theMinnesota Evidence-based Practice Center under Contract No. 290-2007-10064-I.) AHRQ Publication No. 12(13)-E013-EF. Rockville, MD:Agency for Healthcare Research and Quality; October 2012. www.effectivehealthcare.gov/reports/final.cfm.
  28. 28. Thank you!• Contact InformationEric A. LauerEmail: eric.lauer@unh.eduPhone: 603-862-4320

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