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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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Health-Care Utilization as a Proxy in
Disability Determination

Committee on Health Care Utilization and Adults with Disabilities

Board on Health Care Services

Health and Medicine Division

A Consensus Study Report of

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THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by contracts between the National Academy of Sciences and the Social Security Administration (Contract SS00-13-60048, Task Order 8). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-46918-0
International Standard Book Number-10: 0-309-46918-X
Digital Object Identifier: https://doi.org/10.17226/24969

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Copyright 2018 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Health-care utilization as a proxy in disability determination. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24969.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private nongovernment institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public-policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
×

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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on studies’ statements of task by committees of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committees and the committees’ deliberations. Each report has been subjected to a rigorous and independent peer-review process and represents the position of the National Academies on its statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at workshops, symposia, or other events convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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COMMITTEE ON HEALTH CARE UTILIZATION AND ADULTS WITH DISABILITIES

DAN G. BLAZER (Chair), J.P. Gibbons Professor of Psychiatry Emeritus, Duke University Medical Center

JEFF BAZARIAN, Professor of Emergency Medicine, University of Rochester

JENNIFER BOGNER, Professor, Department of Physical Medicine and Rehabilitation, The Ohio State University, Wexner Medical Center

ANNETTE L. FITZPATRICK, Research Professor and Associate Dean for Academic Services, University of Washington School of Public Health

TRACIE C. HARRISON, Professor and Director, Center for Excellence in Long Term Care, School of Nursing, The University of Texas at Austin

PHILIP D. HARVEY, Leonard M. Miller Professor of Psychiatry, University of Miami Miller School of Medicine

MIGUEL HERNAN, Kolokotrones Professor of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University

RENEE Y. HSIA, Professor and Director of Health Policy Studies, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco

NICOLE MAESTAS, Associate Professor of Health Care Policy, Harvard Medical School

JUDITH MCKENZIE, Professor and Division Chief, Division of Occupational Medicine, University of Pennsylvania

KATHLEEN J. MULLEN, Senior Economist and Director, RAND Center for Disability Research, RAND Corporation

LINDA ANH NGUYEN, Clinical Associate Professor of Medicine, Director, Gastrointestinal Motility and Neurogastroenterology, Stanford Medical Center

ALBERT J. OSBAHR III, Medical Director, Corporate Health Services, Spartanburg Regional Healthcare System

KEVIN A. SCHULMAN, Professor of Medicine, Duke University

SETH SEABURY, Director, Keck-Schaeffer Initiative for Population Health, University of Southern California

DONALD H. TAYLOR, JR., Professor, Sanford School of Public Policy, Duke University

Consultants to the Committee

AMY BERNSTEIN, Independent Consultant

NORMAN GROSSBLATT, Editor

NANETTE K. WENGER, Professor of Medicine (Cardiology) Emeritus, Emory University School of Medicine

Study Staff

CAROLYN FULCO, Scholar

BERNICE CHU, Associate Program Officer

JOSEPH GOODMAN, Senior Program Assistant

SHARYL NASS, Director, Board on Health Care Services

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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Reviewers

This consensus study report was reviewed in draft form by persons chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets institutional standards of quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following for their review of this report:

ANDREA L. CHEVILLE, Mayo Clinic

NICOLAAS E. DEUTZ, Texas A&M University

JOHN H. EXTON, Vanderbilt University School of Medicine

JODY SCHIMMEL HYDE, Mathematica Policy Research

ELLEN R. MEARA, The Dartmouth Institute for Health Policy & Clinical Practice

VINCENT MOR, Brown University

SHARON-LISE T. NORMAND, Harvard Medical School

HAROLD POLLACK, The University of Chicago

MICHELLE PUTNAM, Simmons College

CAROL A. ROMANO, Uniformed Services University of the Health Sciences

GEORGE TRIADAFILOPOULOS, Stanford University

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of the report was overseen by ELAINE L. LARSON, Columbia University, and KENNETH I. SHINE, Dell Medical School of The University of Texas. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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Acronyms and Abbreviations

ACA Patient Protection and Affordable Care Act
ADA Americans with Disabilities Act of 1990
ADL activity of daily living
AF atrial fibrillation
AHRQ Agency for Healthcare Research and Quality
AMA American Medical Association
ANPRM Advance Notice of Proposed Rulemaking
APCD All-Payer Claims Databases
ARRA American Recovery and Reinvestment Act
ASL American Sign Language
BMI body mass index
BNP brain natriuretic peptide
CDC Centers for Disease Control and Prevention
CFR Code of Federal Regulations
CHD coronary heart disease
CHF congestive heart failure
CKD chronic kidney disease
CMS Centers for Medicare & Medicaid Services
COBRA Consolidated Omnibus Budget Reconciliation Act of 1985
COPD chronic obstructive pulmonary disease
CVD cardiovascular disease
DOD US Department of Defense
EAP Employee Assistance Program
ED emergency department
EDSS Expanded Disability Status Scale
EMR electronic medical record
EMS emergency medical services
EMTALA Emergency Medical Treatment and Labor Act
FEV Forced Expiratory Volume
FIM functional independence measure
FMLA Family and Medical Leave Act of 1993
FY fiscal year
GCS Glasgow Coma Scale
GERD gastroesophageal reflux disease
GI gastrointestinal
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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HCBS home- and community-based services
HCUP Healthcare Cost and Utilization Project
HDHP high deductible health plan
HF heart failure
HHS US Department of Health and Human Services
HITECH Health Information Technology for Economic and Clinical Health Act
HSA health savings account
IBD inflammatory bowel disease
ICD International Classification of Diseases
IHD ischemic heart disease
IHS Indian Health Service
IOM Institute of Medicine
KCCQ Kansas City Cardiomyopathy Questionnaire
KFF Kaiser Family Foundation
Listings Social Security Listing of Impairments
LTSS long-term services and supports
MEPS Medical Expenditure Panel Survey
MeSH Medical Subject Headings
MI myocardial infarction
NAWHC National Association of Worksite Health Centers
NCHS National Center for Health Statistics
NCQA National Committee for Quality Assurance
NEDS Nationwide Emergency Department Sample
NETT Neurological Emergencies Treatment Trials
NHIS National Health Interview Survey
NIS National Inpatient Sample
NPRM Notice of Proposed Rulemaking
NRD Nationwide Readmissions Database
OIG Office of the Inspector General
OMB Office of Management and Budget
PCMH patient-centered medical home
PCP primary care provider
PM&R physical medicine and rehabilitation
PMADL Performance Measure for Activity of Daily Living
POS point of service
PPO preferred provider organization
QDR National Healthcare Quality and Disparities Report
QOL quality of life
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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SASD State Ambulatory Surgery and Services Databases
SCD sequential compression device
SEDD State Emergency Department Database
SEER Surveillance, Epidemiology, and End Results
SES socioeconomic status
SGA substantial gainful activity
SID state inpatient database
SLE systemic lupus erythematosus
SNF skilled nursing facility
SOT statement of task
SSA Social Security Administration
SSDI Social Security Disability Insurance
SSI Supplemental Security Income
TAVR transcatheter aortic valve replacement
TBI traumatic brain injury
TBSA total body surface area
USCB US Census Bureau
VA US Department of Veterans Affairs
VHD valvular heart disease
VTE venous thromboembolism
WC workers’ compensation
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Health-Care Utilization as a Proxy in Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/24969.
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The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA’s definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for “listing-level” severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

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