Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment

Carey, Iain M.; Hosking, Fay J.; DeWilde, Stephen; Beighton, Carole; Shah, Sunil; Cook, Derek G

doi:10.1136/jech-2016-207557

Cited by 23 publications

(29 citation statements)

References 18 publications

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“…26 Although only about one-half of those eligible currently receive one, 27 we have shown an association between health checks and reduced admissions for ACSCs. 28 Identifying areas where surveillance could be further improved, together with appropriate treatment reflecting their increased risk and unique health care needs, may therefore improve the overall primary care management of adults with intellectual disabilities and potentially reduce unplanned hospital admissions.…”

Section: Discussionmentioning

confidence: 99%

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Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England

et al. 2017

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PURPOSE Adults with intellectual disabilities experience poorer physical health and health care quality, but there is limited information on the potential for reducing emergency hospital admissions in this population. We describe overall and preventable emergency admissions for adults with vs without intellectual disabilities in England and assess differences in primary care management before admission for 2 common ambulatory care-sensitive conditions (ACSCs). METHODSWe used electronic records to study a cohort of 16,666 adults with intellectual disabilities and 113,562 age-, sex-, and practice-matched adults without intellectual disabilities from 343 English family practices. Incident rate ratios (IRRs) from conditional Poisson regression were analyzed for all emergency and preventable emergency admissions. Primary care management of lower respiratory tract infections and urinary tract infections, as exemplar ACSCs, before admission were compared in unmatched analysis between adults with and without intellectual disabilities. RESULTSThe overall rate for emergency admissions for adults with vs without intellectual disabilities was 182 vs 68 per 1,000 per year (IRR = 2.82; 95% CI, 2.66-2.98). ACSCs accounted for 33.7% of emergency admissions among the former compared with 17.3% among the latter (IRR = 5.62; 95% CI, 5.14-6.13); adjusting for comorbidity, smoking, and deprivation did not fully explain the difference (IRR = 3.60; 95% CI, 3.25-3.99). Although adults with intellectual disability were at nearly 5 times higher risk for admission for lower respiratory tract infections and urinary tract infections, they had similar primary care use, investigation, and management before admission as the general population.CONCLUSIONS Adults with intellectual disabilities are at high risk for preventable emergency admissions. Identifying strategies for better detecting and managing ACSCs, including lower respiratory and urinary tract infections, in primary care could reduce hospitalizations. Ann Fam Med 2017;15:462-470. https://doi.org/10.1370/afm.2104. INTRODUCTIONA dults with intellectual disabilities experience poorer health outcomes than their peers in the general population and have higher levels of morbidity and mortality.1 They also receive poorer-quality health care for a range of reasons including discrimination, communication difficulties, and barriers to access.2 Despite international recommendations, 2,3 this group remains largely invisible to routine data collection and analysis. 4 Acute hospitalization is highly undesirable for individuals with intellectual disabilities, and reducing preventable admissions is particularly important.Ambulatory care-sensitive conditions (ACSCs) are those for which prevention or effective management in primary care should decrease the risk of acute hospitalization, and they are widely used as an indicator of access to and quality of primary care. [5][6][7] Studies of admissions for ACSCs in people with intellectual disabilities have shown that this population consistently...

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Section: Discussionmentioning

confidence: 99%

“…28 Identifying areas where surveillance could be further improved, together with appropriate treatment reflecting their increased risk and unique health care needs, may therefore improve the overall primary care management of adults with intellectual disabilities and potentially reduce unplanned hospital admissions.…”

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confidence: 99%

Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England

et al. 2017

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“…The uptake of annual health checks (AHC) remains at approximately 50%. This figure needs to be increased considering the effectiveness of AHC among people with intellectual disabilities in reducing preventable emergency admissions as shown by Carey et al () in their study looking at hospital admissions for people with an intellectual disability from across English GP practices. Authors of this review showed that emergency admissions for conditions that are potentially preventable through better clinical management (e.g.…”

Section: Discussionmentioning

confidence: 99%

Mental and physical health conditions in people with intellectual disabilities: Comparing local and national data

Perera

Audi

Solomou

et al. 2019

Brit J Learn Disabil

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Accessible summary• People with intellectual disability have multiple health problems.• People with intellectual disability have more physical and mental health conditions than people without intellectual disabilities.• People with intellectual disability may need more health checks due to increased prevalence of physical and mental illnesses.• More studies are needed to understand what interventions are effective to reduce health problems in people with intellectual disability. AbstractBackground: Studies have reported increased prevalence of physical and mental health conditions in people with intellectual disabilities (ID) compared to people without intellectual disabilities. However, there are no studies looking into specific health conditions at a national level and comparing with areas that are socio-economically disadvantaged (e.g. low income and low education attainment). This study examines and compares the prevalence of physical and mental health morbidity in people with and without intellectual disabilities at a local and national level in the UK. Method:This study was an anecdotal analysis of physical and mental health data and annual health check-up for England (national), London (regional) and Haringey (innercity borough of London) in 2016/17 using data from the NHS Digital database.Results: Patterns of mental and physical conditions for people with and without intellectual disabilities were similar across Haringey, London and England data. Severe mental illness was more prevalent among people with intellectual disabilities compared to non-intellectual disability peers. This further increased in the inner-city London borough for the intellectual disability group. Certain physical health conditions were also more prevalent in people with intellectual disabilities. Certain activities such as monitoring blood pressure, recording body mass index and checking HbA1C were better in people with intellectual disabilities. Uptake of annual health checks for people with intellectual disabilities remained around 50%.Discussion: This study further highlights the increased prevalence of mental and physical disorders in people with intellectual disabilities compared to people without intellectual disabilities. Further increased risk of mental disorders in an inner London borough compared to national data aligns with existing literature that highlights the 20 |

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“…Olsen et al (1976) found a significant difference between the treatment group (health check recipients) and the control group (non-recipients) in terms of an increase in the number of night hospitalizations for the treatment group. In a study of adults with intellectual disabilities, health check-ups reduced preventable emergency admissions (Carey et al, 2016(Carey et al, , 2017. Our empirical analyses make use of a data set that was provided by the KNHIS.…”

Section: Effects Of General Health Checks On Healthcare Utilizationmentioning

confidence: 99%

The Effect of General Health Checks on Healthcare Utilization: Accounting for Self-Selection Bias

Yoon

Jun

Park

2019

Journal of the Royal Statistical Society Series A: Statistics in Society

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Summary The general health check is one of the most common preventive healthcare measures in many countries. In this study, we propose an empirical approach which jointly models the decision to obtain a general health check and healthcare utilization, tackling the self‐selection problem by using eligibility to obtain a health check for free as an instrumental variable. Eligibility has some exogenous variations by design and this helps us to partial out the effect of general health checks from self‐selection biases. We apply the model to a large 12‐year panel data set provided by the Korean National Health Insurance Service. We find that participation in the general health check increases healthcare utilization and ignored self‐selection generates substantial upward bias in the estimates. We also find that the health check effect shows noteworthy heterogeneity across gender and income groups. Before health checks, healthcare utilization of males and people in low income groups is lower than those of females and people in high income groups respectively. However, these become comparable across different groups after health checks. This finding implies that general health checks can be an effective vehicle for health equity.

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Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment

Cited by 23 publications

References 18 publications

Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England

Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England

Mental and physical health conditions in people with intellectual disabilities: Comparing local and national data

The Effect of General Health Checks on Healthcare Utilization: Accounting for Self-Selection Bias

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