Investigating Disability Factors and Promoting Environmental Access for Healthy Living Rehabilitation Research and Training Center (IDEAL RRTC) Series

The Investigating Disability factors and promoting Environmental Access for Healthy Living Rehabilitation Research and Training Center (IDEAL RRTC) was established to understand and enhance healthy aging for people with long-term physical disabilities, especially those at risk in low-income and racially marginalized communities. In particular, the IDEAL RRTC is focused on investigating the interplay between individual factors and social and environmental barriers and facilitators, as they hinder or promote healthy aging and community participation.

Three of the IDEAL RRTC research projects at the exploratory and discovery phase are designed to enhance understanding of the nature of the person-environment relationship and identify practices, policies, programs, and components of the built environment that either support or impede the health of adults aging with long-term physical disabilities, particularly those from diverse socioeconomic backgrounds.

• Identification of protective factors—analyses of existing national longitudinal claims databases: This three-part project examined claims data from Medicare, Medicaid, and Optum databases to explore aging trajectories, use of preventative services, and healthcare outcomes for individuals with various types of physical disabilities.
  • Part A: Aging trajectories of chronic disease, psychological morbidity, and mortality.
  • Part B: Effect of variation in health coverage, employment, and community resources on adverse events and healthcare costs and utilization.
  • Part C: Evaluation of Affordable Care Act and Medicaid managed long-term services and supports policies on health care and community living outcomes for individuals with long-term physical disabilities.
• Multimethod community inquiry: This three-part project will use various methods of engaging individuals and community organizations to identify environmental factors, programs, and supports perceived as supporting healthy aging for people with a physical disability.
  • Part A: Qualitative community inquiry: This qualitative study is designed to identify the environmental factors that promote or support healthy aging with a long-term physical disability as perceived by individuals with long-term physical disabilities from low-income and racial/ethnic minority backgrounds who have been successful in this process.
  • Part B: Surveys of community members: This cross-sectional study uses surveys with individuals with long-term physical disabilities from low-income and minority communities to identify environmental factors that support healthy aging.
  • Part C: Survey of disability organizations: This project will use a national survey of disability organizations to identify best practices for promoting healthy aging with physical disabilities and personal and environmental factors that mediate the effectiveness of community living outcomes among diverse communities.
• Examination of the built and social environment: This project addressed the gap in knowledge about the role of environmental factors in the health of persons aging with long-term physical disabilities by examining 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.

Two IDEAL RRTC research projects at the intervention development stage will create innovative and evidence-based approaches to enhance access to health care and community supports.

• Model primary care clinic for adults with long-term disabilities: The two main aims of the project are (1) to design, pilot, and evaluate an accessible, integrated health program for people with a physical disability at a primary care clinic, scalable for other integrated health centers, and (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 people with a physical disability.
• Transportation access: This two-part project will quantify changes in transportation needs and priorities, and patterns of Americans with Disabilities Act paratransit use among people with a physical disability aging in a defined geographical area across time. The project will then develop a prototype data-driven web-based decision tool for transportation service providers, city/county planners, and disability organizations to inform and better coordinate transportation services to support successful aging in people with a physical disability.