603 - Development of the Diagnosis-to-Impairment Types Algorithm and Youth with Disabilities
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 603 Publication Number: 603.32
Alyna Chien, Boston Children's Hospital / Harvard Medical School, Boston, MA, United States; Sarah J.. Spence, Boston Children's Hospital, Boston, MA, United States; Megumi J. Okumura, UCSF, San Francisco, CA, United States; Sifan Lu, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Christina H. Chan, Boston Children's Hospital, Boston, MA, United States; Amy Houtrow, University o Pittsburgh, Pittsburgh, PA, United States; Dennis Kuo, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Jeanne Van Cleave, University of Colorado School of Medicine, Aurora, CO, United States; Susan Shanske, Boston Children's Hospital, Boston, MA, United States; Mark Schuster, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States; Karen Kuhlthau, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Sara Toomey, Boston Children's Hospital/Harvard Medical School, Boston, MA, United States
Associate Professor, General Pediatrics Boston Children's Hospital / Harvard Medical School Boston, Massachusetts, United States
Background: Youth with disabilities are youth with life-long functional impairments who are at elevated risk for poor health, health care, and early mortality. Objective: To develop the Diagnosis-to-Impairments Algorithm (DITA), a novel claims-based method for characterizing the types of impairments affecting people with disabilities (physical, sensory, developmental, psychiatric, intellectual); and examine the prevalence of youth with disabilities and their impairment types in a state-level dataset that allows comparison of those insured commercially versus by Medicaid. Design/Methods: This study creates DITA from the previously validated Children with Disabilities Algorithm (CWDA) through four independent rounds of physician expert review as part of a consensus process. Both were applied to Colorado’s All-Payer Claims Dataset 2014-2018 to identify 10-26-year-olds with disabilities and their impairment types, 392,444 of whom were insured by commercial insurers only and 333,931 by Medicaid only. Results: The prevalence of youth with disabilities was greater among the Medicaid-insured by 7.6 percentage points (commercial: 4.3% [16,907 of 392,444] versus Medicaid: 11.9% [47,654 of 333,931). Most youth with disabilities had a single impairment (commercial: 76.4% [12,915 of 16,907], Medicaid: 66.5% [31,690 of 47,654]). The prevalence of impairment types was comparable across insurance sources for impairments that were: physical (commercial: 48.0% [8,121 of 16,907], Medicaid: 54.7% [26,054 of 47,654]); developmental (commercial: 31.3% [5,290 of 16,907], Medicaid: 35.4% [16,874 of 47,654]); and sensory (commercial: 17.4% [2,948 of 16,907], Medicaid: 12.0% [5,735 of 47,654]). However, psychiatric impairments were more prevalent among the Medicaid-insured by 6.7% percentage points (commercial: 14.6% [2,470 of 16,907] versus Medicaid 21.3% [10,175 of 47,654]) and intellectual impairments were more prevalent among the Medicaid-insured by 9.3 percentage points (commercial: 16.9% [2,858 of 16,907] versus Medicaid: 26.2% [12,501 of 47,654]).
Conclusion(s): The Diagnosis-to-Impairments Algorithm (DITA) is a novel method for understanding the functional impairments affecting youth with disabilities and this study delivers a test-of-concept analysis in an example state. Because DITA translates the diagnostic codes that physicians use into a language that better reflects the concerns of people with disabilities, DITA is aligned with the World Health Organization’s vision of moving towards functioning and child development towards a common language that “can be used across disciplines, government sectors and national boundaries.”
