title: The complex web of health: relationships among chronic conditions, disability, and health services.
abstract: OBJECTIVE
  A critical issue in health-care reform concerns how to realign health-care delivery systems to manage medical care services for people with ongoing and costly needs for care. We examined the overlapping health-care needs of two such population groups among the U.S. working-age population (those aged 18-64 years): people with chronic medical conditions and people with disabilities.
  
  
  METHODS
  Using the Medical Expenditure Panel Survey (2002-2004), we examined differences in health status, service use, and access to care among and between working-age adults reporting disabilities and/or one or more chronic conditions. We also analyzed people with three key chronic conditions: arthritis, diabetes, and depression.
  
  
  RESULTS
  More than half of working-age people with disabilities reported having more than one chronic condition. Among those with activities of daily living or instrumental activities of daily living limitations, 35% reported four or more chronic conditions at a time. We found considerable variability in access problems and service use depending on how we accounted for the overlap of multiple conditions among people with arthritis, diabetes, and depression. However, disability consistently predicted higher emergency department use, higher hospitalization rates, and greater access problems.
  
  
  CONCLUSIONS
  The overall prevalence of chronic conditions among the U.S. working-age population, coupled with the high concentration of multiple chronic conditions among those with disabilities, underscores the importance of reforming health-care delivery systems to provide person-centered care over time. New policy-relevant measures that transcend diagnosis are required to track the ongoing needs for health services that these populations present.
authors.affiliation: National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Building 10, CRC, Room 1-1469, 10 Center Dr., MSC-1604, Bethesda, MD 20892-1604, USA. gulley@brandeis.edu
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Gulley
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Rasch
authors.forename: Leighton
authors.initials: L
authors.lastname: Chan
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration*; D006233:Persons with Disabilities; D005260:Female; D018166:Health Care Reform / Q000458:organization & administration; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D015995:Prevalence; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult