Emergency department use among young adult Medicare beneficiaries with autism and intellectual disabilities

Benevides, Teal; Carretta, Henry; Graves, Katelyn Y.; Sikka, Veronica

doi:10.1016/j.rasd.2019.101470

Cited by 12 publications

(18 citation statements)

References 24 publications

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“…Although this approach is supported by research evidence (Benevides et al, 2019) and precedent (e.g. Benevides et al, 2020; Hand et al, 2020; Leslie & Martin, 2007; Maddox et al, 2018), we also conducted a sensitivity analysis to determine the extent to which using more stringent criteria to identify autistic adults (at least one inpatient or two outpatient encounters) may have altered our findings. Of the 22 physical health conditions and nine mental health conditions examined, the results of our sensitivity analysis differed from our primary analysis for only one condition, diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Requiring only one ASD diagnosis has been shown to be appropriate for identifying autistic individuals in Medicare claims (Benevides et al, 2019) and has been used in prior studies of healthcare claims data (e.g. Benevides et al, 2020; Hand et al, 2020; Leslie & Martin, 2007; Maddox et al, 2018). ASD diagnoses were identified using International Classification of Diseases, 10th edition (ICD-10) codes F84.0, F84.1, F84.5, or F84.9.…”

Section: Methodsmentioning

confidence: 99%

“…Requiring only one ASD diagnosis has been shown to be appropriate for identifying autistic individuals in Medicare claims (Benevides et al, 2019) and has been used in prior studies of healthcare claims data (e.g. Benevides et al, 2020;Hand et al, 2020;Leslie & Martin, importance of developing distinct, tailored health management strategies for the autistic older adults with and without intellectual disability.…”

Section: Study Populationmentioning

confidence: 99%

See 2 more Smart Citations

Health status of Medicare-enrolled autistic older adults with and without co-occurring intellectual disability: An analysis of inpatient and institutional outpatient medical claims

Gilmore

Harris

Longo

et al. 2020

Autism

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Little is known about the extent to which the healthcare needs of autistic older adults with intellectual disability differ from autistic older adults without intellectual disability. We conducted a cross-sectional retrospective cohort study of Medicare claims data from 2016 to 2017 to compare the prevalence of physical and mental health conditions among autistic older adults (age 65+ years) with intellectual disability ( N = 2054) to autistic older adults without intellectual disability ( N = 2631). Medicare claims data consisted of records from inpatient hospitalizations and institutional outpatient visits (i.e. visits to hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, Federally Qualified Health Centers, and community mental health centers). Examination of the largest between-group differences revealed that autistic older adults with intellectual disability had 350% greater odds of epilepsy (odds ratio = 4.5, 95% confidence interval = 3.9–5.2), 170% greater odds of osteoporosis (odds ratio = 2.7, 95% confidence interval = 2.3–3.2), and 100% greater odds of gastrointestinal conditions (odds ratio = 2.0, 95% confidence interval = 1.8–2.2) but 80% lower odds of attention deficit disorders (odds ratio = 0.2, 95% confidence interval = 0.1–0.3), 70% lower odds of substance use disorders (odds ratio = 0.3, 95% confidence interval = 0.2–0.4), and 60% lower odds of suicidal ideation or intentional self-injury (odds ratio = 0.4, 95% confidence interval = 0.3–0.6). These findings highlight the importance of developing tailored health management strategies for the autistic older adult population as a function of intellectual disability status. Lay abstract Little is known about the extent to which the healthcare needs of autistic older adults with intellectual disability differ from autistic older adults without intellectual disability. Our study is the first, to our knowledge, to use US national data to compare physical and mental health conditions among autistic older adults with and without intellectual disability. The data analyzed in this study consisted of records from inpatient hospitalizations as well as “institutional outpatient” healthcare visits, which include visits to hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, Federally Qualified Health Centers, and community mental health centers. Autistic older adults with intellectual disability were significantly more likely to have thyroid disorders, epilepsy, respiratory infections, gastrointestinal conditions, osteoporosis, cognitive disorders, and schizophrenia/psychotic disorders. In contrast, autistic older adults without intellectual disability were significantly more likely to have obesity, diabetes, high blood pressure, cerebrovascular disease, chronic obstructive pulmonary disease, arthritis, back conditions, attention deficit disorders, substance use disorders, and suicidal ideation or intentional self-injury. These findings highlight the importance of developing distinct, tailored health management strategies for the autistic older adults with and without intellectual disability.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Requiring only one ASD diagnosis has been shown to be appropriate for identifying autistic individuals in Medicare claims (Benevides et al, 2019) and has been used in prior studies of healthcare claims data (e.g. Benevides et al, 2020;Hand et al, 2020;Leslie & Martin, importance of developing distinct, tailored health management strategies for the autistic older adults with and without intellectual disability.…”

Section: Study Populationmentioning

confidence: 99%

See 1 more Smart Citation

Health status of Medicare-enrolled autistic older adults with and without co-occurring intellectual disability: An analysis of inpatient and institutional outpatient medical claims

Gilmore

Harris

Longo

et al. 2020

Autism

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“…Alternatively, these findings may suggest that autistic adults with an intellectual disability are less likely to have a centralized place where they receive primary care. These results contribute to a growing body of literature on differences in the healthcare needs and utilization patterns of autistic individuals with and without cooccurring intellectual disability (Benevides et al, 2020;Hand et al, 2019aHand et al, , 2019b.…”

Section: Discussionmentioning

confidence: 56%

Specialized primary care medical home: A positive impact on continuity of care among autistic adults

Hand

Coury

White

et al. 2020

Autism

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While the medical home has proven effective at improving continuity of care among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. We conducted a retrospective cohort study to compare the continuity of care of autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the Center for Autism Services and Transition (CAST), to propensity score matched national samples of autistic adults with private insurance or Medicare. The unadjusted median Bice–Boxerman continuity of care index was 0.6 (interquartile range = 0.4–1.0) for CAST patients, 0.5 (interquartile range = 0.3–1.0) for Medicare beneficiaries, and 0.6 (interquartile range = 0.4–1.0) for privately insured autistic adults. In multivariable models controlling for demographic characteristics, on average, CAST patients had continuity of care indices that were 10% higher than national samples of autistic adult Medicare beneficiaries (p < 0.0001). Continuity of care among CAST patients did not significantly differ from that of the national sample of privately insured autistic adults (p = 0.08). Our findings suggest that medical homes, like CAST, may be a promising solution to improve healthcare delivery for the growing population of autistic adults. Lay abstract There is a nationally recognized need for innovative healthcare delivery models to improve care continuity for autistic adults as they age out of pediatric and into adult healthcare systems. One possible model of care delivery is called the “medical home”. The medical home is not a residential home, but a system where a patient’s healthcare is coordinated through a primary care physician to ensure necessary care is received when and where the patient needs it. We compared the continuity of care among autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the CAST, to matched national samples of autistic adults with private insurance or Medicare. Continuity of primary care among CAST patients was significantly better than that of matched national samples of autistic adult Medicare beneficiaries and similar to that of privately insured autistic adults. Our findings suggest that medical homes, like CAST, are a promising solution to improve healthcare delivery for the growing population of autistic adults.

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“…Individuals on the autism spectrum may require a greater degree of interaction with health services due to the multitude of medical comorbidities that often present alongside autism (e.g., gastrointestinal issues, psychiatric conditions, intellectual disabilities; Benevides, Carretta, Graves, & Sikka, 2020 ; Croen et al, 2015 ; Levy et al, 2010 ). Yet, despite the higher rates of contact with both emergency and non-emergency healthcare ( Weiss et al, 2018 ; Zerbo et al, 2019 ), autistic 1 individuals tend to have poorer health outcomes ( Cashin, Buckley, Trollor, & Lennox, 2016 ; Croen et al, 2015 ), engage less with preventative care ( Cummings et al, 2016 ; Nicolaidis et al, 2013 ), have lower health-related quality of life ( Kuhlthau, McDonnell, Coury, Payakachat, & Macklin, 2018 ), and higher mortality rates ( Hirvikoski et al, 2016 ; Woolfenden, Sarkozy, Ridley, Coory, & Williams, 2012 ) than others.…”

Section: Introductionmentioning

confidence: 99%

Development and evaluation of a novel caregiver-report tool to assess barriers to physical healthcare for people on the autism spectrum

Walsh

Lydon

Hehir

et al. 2020

Research in Autism Spectrum Disorders

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Highlights A novel caregiver-report Barriers to Healthcare tool for autistic individuals was developed and evaluated. Results suggest that barriers to healthcare occur at the patient, healthcare-provider and systems levels. Autism severity, anxiety, general adjustment problems, age, and having unmet needs significantly predicted barriers endorsed. This tool may guide the development and evaluation of initiatives to reduce healthcare barriers for autistic individuals;

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Emergency department use among young adult Medicare beneficiaries with autism and intellectual disabilities

Cited by 12 publications

References 24 publications

Health status of Medicare-enrolled autistic older adults with and without co-occurring intellectual disability: An analysis of inpatient and institutional outpatient medical claims

Health status of Medicare-enrolled autistic older adults with and without co-occurring intellectual disability: An analysis of inpatient and institutional outpatient medical claims

Specialized primary care medical home: A positive impact on continuity of care among autistic adults

Development and evaluation of a novel caregiver-report tool to assess barriers to physical healthcare for people on the autism spectrum

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