Access to Health Care Elusive for Americans with Disabilities
Findings from a 5-year study by the National Rehabilitation Hospital (NRH) Center for Health and Disability Research, Washington, DC, suggest that some Americans with disabilities are having trouble gaining access to health care.
The study, which surveyed 533 people with physical disabilities, showed that half reported not being able to receive the care they needed. “It is discouraging news,” says Ed Healton, MD, medical director of NRH. “Originally, this study was an attempt to compare managed care with traditional insurance plans. In the end, it revealed some results that we are not happy about.”
Of those surveyed, 51% of respondents with spinal cord injury, cerebral palsy, or multiple sclerosis covered by managed care were able to receive medical rehabilitation when needed, while 52% in fee-for-service health plans reported the same. Additionally, other survey data showed that people with mobility limitations are not getting preventive care at the same level as those without disabilities. For example, the odds of women with disabilities receiving a Pap smear or mammogram are 30% lower than those without disabilities.
While Healton says it is too soon to talk about what the NRH’s response to the data might be, he does say, “This is indeed something we need to address. The study shows that doctors’ offices are often not accessible to those with disabilities. In addition, it shows that primary care physicians are not trained to conduct examinations for people who use a wheelchair or cannot climb onto a table for examination, for example.”
The NRH study was conducted in tandem with the Independent Living Research Utilization Center, Houston, and funded by a grant from the National Institute on Disability and Rehabilitation Research. Among the federal data sources used were the Medical Expenditure Panel Survey and the Medicare Beneficiary Survey.
NRH, founded in 1986, is Washington, DC’s largest provider of medical rehabilitation services for a complete range of neurological and orthopedic conditions.
Jennifer Elisseef, PhD
Tissue from Stem Cells May Help Repair Joints
Researchers at Johns Hopkins University, Baltimore, have enabled stem cells from goats to grow into tissue resembling cartilage, possibly paving the way to a new way to repair joints.
Led by Jennifer Elisseeff, PhD, assistant professor in the school’s Department of Biomedical Engineering, the tissue engineering team is testing a method that would allow doctors to inject a fluid filled with stem cells and nutrients into damaged tissue, then use light to harden the liquid into a stable gel. Stem cells within the gel would then multiply and form new bone or cartilage to replace the injured tissue.
Elisseeff’s laboratory is using adult goat multipotent cells, which means they can be stimulated to produce different types of musculoskeletal tissue. Theoretically, patients preparing for cartilage or bone repairs would be able to donate their own stem cells prior to the procedure, reducing the potential for infection and tissue rejection.
Elisseeff’s research team also includes a plastic surgeon, orthopedic surgeon, polymer chemist, and several graduate students, all part of the Whitaker Biomedical Engineering Institute at Johns Hopkins.
While clinical use of such a procedure is probably years away, the team will likely begin testing the process on mice this fall, with the goal of developing a new way to deliver and control the behavior of adult stem cells to restore bone and cartilage that have been damaged by disease or injury or are impaired by a genetic defect. One of the benefits of this method would be that patients could end up with living tissue, rather than metal or plastic replacement parts, assuming the laboratory results can be replicated in humans.
Elisseeff’s team is currently working on fine-tuning the technique in the laboratory. They are synthesizing a new hydrogel that should degrade harmlessly in the body after the new tissue develops. Also, the team is refining its cell growth methods to more closely mimic the normal developments of cartilage and bone cells. Elisseeff and her colleagues have submitted some of these laboratory results to a peer-reviewed journal.
Pittsburgh School District First to Use Concussion System
The Pittsburgh Public School District has become the first such district in the United States to implement a computerized sports concussion evaluation system to assess the severity of concussions and help determine when it is safe for athletes to return to play.
The Immediate Post-concussion Assessment and Cognitive Testing system (ImPACT), developed by researchers at the University of Pittsburgh Medical Center Sports Medicine Concussion Program, will be used beginning this fall by athletes who play contact sports in all 10 of Pittsburgh’s public high schools. Some studies have shown that at least 10% of athletes involved in contact sports such as high school football and soccer sustain a concussion each season.
ImPACT will allow certified athletic trainers and team physicians to efficiently collect and store baseline data on each athlete’s normal neurocognitive state by having them take a 20-minute computerized test measuring brain processing, speed, memory, and visual motor skills.
If an athlete suffers a concussion during the season, he or she is tested again and the baseline neurocognitive data compared to postconcussion data to help determine the effects of the injury.
ImPACT is already being used by dozens of high schools in western Pennsylvania, as well as 150 high schools and 70 colleges across the United States. It is also used by the National Football League and several other national and international professional athletic organizations.
The 10 Pittsburgh public high schools are Allerdice, Brashear, Carrick, Langley, Oliver, Peabody, Perry, Schenley, South Vo-Tech, and Westinghouse. Athletes from these schools involved in fall sports will be baseline tested before the fall season’s contact practice sessions begin.
Orthopods Turn to Rehab for Revenue
According to the August 16 edition of Eli’s Rehab Report, physical therapists working in private practice and hospital outpatient rehabilitation units could soon be dealing with a depleted customer base, as more and more orthopedic physicians provide rehabilitation in-house.
More than ever, orthopedic physicians are looking at rehab as a viable business line, in part due to being hit hard by rising malpractice insurance rates and being squeezed out by managed care. Searching for ways to generate revenue, they are starting to accept more rehab patients in-house, putting them in competition with ambulatory rehab providers.
In the past, orthopedic physicians in group practices have referred more expensive patients to rehab facilities. However, evidence suggests that they are now only sending over indigent and Medicaid patients, saving private pay and Medicare patients for themselves.
