An observational cohort study of numbers and causes of preventable general hospital admissions in people with and without intellectual disabilities in England

Abstract

Background Hospital admissions for preventable reasons [ambulatory care sensitive (ACS) conditions] can indicate gaps in access to or quality of primary care. This paper seeks to document the numbers and causes of these admissions in England for people with intellectual disabilities (ID) compared with those without.Methods Observational cohort study of number and duration of emergency admitted patient episodes for ACS conditions, overall and by cause, using the Clinical Practice Research Datalink GOLD primary care database and the linked Hospital Episode Statistics Admitted Patient Care dataset. Results The study covered 5.2% of the population of England from April 2010 to March 2014 giving a total population base of 59 280 person-years for people with ID and 11 103 910 for people without identified ID. The rate of emergency admissions for ACS conditions for people with ID was 77.5 per 1000 person-years. As a crude comparison, this was 3.0 times the rate for those without ID, but standardising for the distinct demography of this group, the number of episodes was 4.8 times that expected if they had the same age-specific and sex-specific rates. Stay durations for these episodes were longer for both young-age and working-age people with ID. Overall people with ID used 399.8 beddays per 1000 person-years. As a crude comparison, this is 2.8 times the figure for people without ID. Standardising for their age and sex profile, it is 5.4 times the number expected if they had the same age-specific and sex-specific rates. For patients with ID, 16.6% (one in six) of all admitted patient episodes and 24.3% (one in four) of in-patient care days for people with ID were for ACS conditions. Corresponding figures for those without ID were 8.3% (one in 12) and 14.4% (one in seven). The difference in rates between those with and without ID was most marked in people of working age. The three most common causes of emergency episodes for ACS conditions in people with ID were convulsions and epilepsy, influenza pneumonia and aspiration pneumonitis. Influenza pneumonia was also a common cause for people without ID. Episodes for convulsions and epilepsy and aspiration pneumonitis were specifically associated with people with ID. Conclusions Rates of hospital admissions for ACS conditions provide an important indicator of health literacy, basic self-care (or support by carers) and the accessibility of primary care. High rates are seen for some conditions specifically associated with premature death in people with ID. Local monitoring of

Potentially preventable hospitalisations of people with intellectual disability in New South Wales

“…In the first Australian study of potentially preventable hospitalisations of people with intellectual disability, we found that age‐standardised rates were higher than for the general NSW population, without clear patterns of change in differences during 2001‒2015. Our findings are in line with findings from Canada, the United States of America, and the United Kingdom that rates of potentially preventable hospitalisation are higher for people with intellectual disability 8-11 . We found that rates were particularly high for hospitalisations for acute conditions, for which overall rates were five to eight times as high for people with intellectual disability as for the general population; the rates for admissions with vaccine‐preventable conditions were about three times as high.…”

“…One marker of poor access to appropriate primary and community‐based health care is the higher rate of potentially preventable hospitalisations for people with intellectual disability than for people without intellectual disability, as reported overseas 8-11 . In Australia, potentially preventable hospitalisations are a performance indicator of health care accessibility and effectiveness; twenty‐two ambulatory care‐sensitive conditions are encompassed by this indicator, including vaccine‐preventable, acute, and chronic conditions 12 .…”

A systematic review of community psychosocial group interventions for adults with intellectual disabilities and mental health conditions

“…Standard psychosocial interventions for the general population are described as techniques, which target biological, behavioural, cognitive, emotional, interpersonal, social, or environmental factors can improve a person's health, function, and well‐being (England et al, 2015). Psychosocial interventions with adults who have an intellectual disability and mental ill health is an area in which there is limited research particularly internationally, even though factors which psychosocial interventions target are beneficial (Glover et al, 2020). This review underlines the lack of provision particularly with people who have varying levels of ability.…”

Healthcare utilisation and unmet health needs in children with intellectual disability: a propensity score matching approach using longitudinal cohort data

“…However, the challenges inherent in examining healthcare utilisation for children with ID necessitate the use of such data when hospital administrative data is unsuitable due to poor coding and a lack of diagnosis for children with ID (Emerson and Hatton 2013). Moreover, the clinical reasons and degree of the severity of illness for use of health services was not reported, which limited our ability to identify disparities in reasons for use and critically, if children with ID have a greater risk of avoidable hospitalisation for instance, ambulatory care sensitive conditions (Glover et al 2020) and/or differences in attendance for physical or mental health illness. Finally, due to the small sample sizes available, we were unable to examine disparities across categories of ID to determine whether those with severe and profound disability are at greater risk than those with mild or moderate disability.…”