Measuring use of health services among working age adults with disabilities with the ACS-6: What constitutes elevated service need and use?

The six question disability measure developed for use in the American Community Survey (ACS-6) is currently being adopted as a new standard for disability measurement. Section 4302 of the Affordable Care Act further extended the adoption of the ACS-6 and HHS has called for its inclusion in all national surveys of population health accordingly. These six questions, covering difficulties with vision, hearing, walking, cognition and activities of daily living, were composed with the purpose of identifying persons at elevated risk for participation restrictions. They were not composed with an explicit focus on health care needs or service use, though they will drive how health services researchers measure disability for many years to come. Using nationally representative data on community-dwelling, working aged individuals from the 2011 NHIS, we examine how each of the separate ACS-6 questions are related to annual healthcare use, including primary and specialty doctor visits, hospitalizations, ED visits, mental health, therapies and home health, in both bivariate and multivariate analyses. We compare and contrast several different approaches to identifying subpopulations of persons with disabilities who have elevated health care utilization patterns using this new standard for disability measurement. Self-reported difficulty with ADLs/IADLs was consistently associated with higher health service utilization in nearly all service categories we examined. We conclude that the ACS-6 provides an important, cross-survey window for analyzing health care utilization by people with disabilities, while also noting areas where additional disability-related content could supplement this new standard.