Project Directors: Elham Mahmoudi, PhD & Mark Peterson, PhD, MS

Despite the well-established interrelationships between access to healthcare and age-related multimorbidity, adverse health events, and cost of care among the population, the extent to which health outcomes and healthcare costs for adults with disabilities interact with a wide range of social factors, including type and depth of insurance coverage, has received little attention. There is also a paucity of evidence regarding the aging trajectories of chronic diseases and psychological morbidities among adults with these conditions, as well as how these factors contribute to healthcare costs and adverse health events, including early mortality. Three specific aims guide this research investigation

Determine the longitudinal trends of cardiometabolic diseases, multimorbidity, diagnosed physiological conditions, and musculoskeletal diseases common among individuals diagnosed with a physical disability stratified by type of insurance (public vs. private). 
Identify the independent and joint contributions of medical factors (e.g., age, multi-morbidity, disease severity, etc.) and social and environmental factors (e.g., income, education, and insurance) on adverse health events (including mortality), healthcare use, and costs.
Quantify how changes in medical and social factors predict or mediate adverse health events and healthcare costs among individuals with specific diagnoses of physical disabilities.

Project Directors: Elham Mahmoudi, PhD & Mark Peterson, PhD, MS

This study makes use of existing national databases to examine various health outcomes among individuals with disability. Using 2007-2016 Medicaid and Medicare Data, we will conduct three separate types of analyses:

Examine the effect of interstate variation in health coverage and related health policies on adverse health events and health outcomes among youth and adults with disability;
Examine the effect of county-level variation in employment and community participatory living on adverse health and health outcomes among youth and adult with disability;
Examine the effect of interstate variation in Medicaid long-term care and community centers on health outcomes among youth and adult with disability. 

Project Director: Robyn Rontal, MHSA

This study will provide information about the effect of recent federal and state policies on the health and community living outcomes for individuals with physical disabilities. The intersection between research and policy is significant because it helps inform specific program interventions and supports future policy decision-making that impacts this vulnerable population. This study has two components:

Examine the effect of the Affordable Care Act (ACA) on the use of preventive services, adverse health events, and cost and utilization of health care services among individuals with physical disabilities.
Examine the effect of various state-level programs, implementing Medicaid managed long-term services and supports (MLTSS) policies, on individuals with physical disabilities.
 

Project Director: Michelle A. Meade, PhD
Postdoctoral Fellow: Lisa Reber, PhD

This qualitative study will conduct remote interviewswith adults with long-term physical disabilities and key informant interviews to identify the environmental factors, including the policies, community programs, and personal supports, that are identified as supporting or promoting healthy aging in two low-income and racially/ethnically marginalized communities in Michigan.

Interviews will be held remotely using Zoom Video Communication. Participants can either call in on their phone or connect using their computer.

Potential participants will be identified through community and disability organizations and either contacted through mailings or asked to self-identify in response to advertisements in local papers or other outlets. A stratified sample of 60 individuals will be recruited to participate in focus groups and an addition 12 people nominated to participate in key informant interviews to be held at private, community locations. Stratification will occur based on residence (Detroit vs. Flint area), onset of disability (congenital or pediatric vs. adult onset), and gender. All focus group and interviews will be recorded, transcribed and analyzed to identify key themes. Findings from this study will be used to inform the development of a community and national survey as well as knowledge translation activities.

Project Director: Rie Suzuki, PhD

This study will use cross-sectional surveys to identify environmental factors that support healthy aging among individuals with long-term physical disabilities from low income and minority communities. The specific research questions in this project are:

• What kinds of the systems, policies and community programs do adults with physical disabilities use and how helpful do they perceive them to be?
• Does use of these social recourses improve health outcomes?
• Do individuals from different backgrounds seem to differentially benefit from the social resources available to them?

Project Director: Melissa Riba, MA

Download the survey instrument (PDF file)

This component of the project will use a national survey of disability organizations to identify best practices for promoting healthy aging with physical disabilities and personal and the environmental factors that mediate the effectiveness of community living outcomes among diverse communities. This survey will incorporate insights gained from focus groups and key informant interviews in its design and questions. The results of this survey will be integrated with IDEAL RRTC research findings to inform and guide the design and implementation of our proposed research interventions. The survey will also provide information that will inform health providers, community organizations, community health workers, policymakers, and members of the disability community to further advance community, state and federal policies to reduce disparities and improve health aging for adults with physical disabilities. Dissemination may include issue briefs, webinars, research papers and conference presentations.

Project Director: Philippa Clarke

To date, there has been little research on environmental factors to guide interventions and treatments to improve the health of persons aging with long-term physical disabilities. This project will begin to fill this gap in knowledge by examining the role of characteristics in the social and built environment as they interact with underlying impairments  and activity limitations to either hinder or promote the full participation of individuals with physical disabilities in society. We will build off Project 1 by linking multiple dimensions of the built and social environment to the health trajectories of individuals in the combined Medicare and Medicaid Data file over a period of 10 years (2007-2016).

We focus on those neighborhood characteristics hypothesized to be related to healthy aging with physical disability, including the density of recreational centers, public transportation, and neighborhood socioeconomic indicators. We examine indicators of neighborhood safety (based on local crime statistics), since fear of crime may discourage individuals from fully accessing resources in their neighborhood. Based on our previous work which showed that snow and ice keep older adults homebound (Philippa J. Clarke et al., 2015), we will also include measures of average temperature and precipitation. Measures of street connectivity tap the connected routes within communities, which may facilitate access to social and physical resources. In addition, socioeconomic disadvantage, racial residential segregation, home foreclosure rates, and low employment opportunities, capture the social environment.

We hypothesize that, all other factors being equal, adults aging with physical disabilities in safe, accessible environments with more social and physical resources will experience fewer hospitalizations and decreased mortality compared to those living in areas with fewer resources. Results from this project at the exploratory and discovery stage of research will inform the intervention stages with evidence-based knowledge on the person-environment fit.

All the neighborhood built and social environment data has been made available to the larger research and user community through ICPSR (data sharing core). Visit ICPSR's National Neighborhood Data Archive (NaNDA) page for more information.

Project Directors: Michael McKee, MD and Elham Mahmoudi, PhD

Premature multimorbidity and adverse health events are more common among persons with physical disabilities (PWPD) compared with population norm. Research shows that healthy aging is strongly influenced by patients’ social, behavioral, and environmental variables. However, patients’ information on social and functional status factors is not systematically collected and therefore is not used in medical decision making to promote healthy aging among this vulnerable population.

There is evidence that primary care generates the largest ability to reduce illness and premature death, as well as provide more equitable health care in populations, yet little is known how this can be achieved effectively for PWPD. The CDC has provided suggested recommendations to address the existing gaps for individuals with disabilities. These actions include: a) providing a system in which PWPD at risk for premature death can be identified to provide additional health care and social services that may be needed; b) tailor health care services, including health education and prevention, for PWPD whose needs differ from the typical patient population; c) improve the inclusion of behavioral health interventions for PWPD; and d) provide care management for PWPD by health care staff trained to work with this population.  

This two-part research project will develop a model primary care clinic for adults with long-term disabilities. The two main sections of this projects are:

1. To design, pilot, and evaluate an accessible, integrated health program for PWPD at a primary care clinic, scalable for other integrated health centers
2. To assess how the systematic collection of social and functional status information and use of this information by care managers may reduce adverse health events and improve social and functional status of PWPD

Project Director: Clive D’Souza, Ph.D.

Access to safe, accessible and useable transportation options is vital to supporting social interactions, community participation, positive health behaviors, and successful aging among people with disabilities. However, community-level transportation decisions to promote health and community participation, and risk of secondary conditions among people aging with physical disabilities is undermined by the lack of evidence-based information. Data on ADA paratransit users and usage patterns is a valuable resource to this end but remains an under-utilized resource due to it being fragmented and inaccessible to decision-makers.

The specific aims of this project are:

1. To quantify changes in transportation needs and priorities, and patterns of ADA paratransit use among people aging with long-term physical disabilities in a defined geographical area across time
2. To incorporate this information into a prototype intervention, namely, a data-driven web-based decision tool for transportation service providers, city/county planners, and disability organizations to identify gaps in, and collectively improve and coordinate transportation services to support successful aging in people with long-term physical impairments

Disability, Aging, and Demand-Response Transportation tool

Disability, Aging and Demand Response Transportation Website Link: 
https://www.includable.org/paratransit/index.php

Ann Arbor Paratransit Data Explorer Tool Link:  
https://www.includable.org/paratransit/a2explorer/index.php

**The site is open access, but users need to signup (login and password). This this is at no-cost (free). Once users have created an account (or logged in), click on Projects and then Disability, Aging and Demand-Response Transportation. **