Hospitalizations of Adults With Intellectual Disability in Academic Medical Centers

Ailey, Sarah H.; Johnson, Tricia J.; Fogg, Louis; Friese, Tanya R.

doi:10.1352/1934-9556-52.3.187

Cited by 23 publications

(18 citation statements)

References 14 publications

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“…8 There have been 3 other large-scale studies on hospitalizations of intellectually disabled adults, but they were unable to differentiate between emergency and planned admissions. 9,20,21 Our focus on preventable emergency admissions means that any comparison is difficult, as we would not expect good primary care management to decrease planned admissions for ACSCs.…”

Section: Contextmentioning

confidence: 99%

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: Contextmentioning

confidence: 99%

Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England

et al. 2017

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“…Regarding the second research question, Table summarizes the three studies that consider an overview on whether people with intellectual disabilities are admitted for the same reasons as the general population (Ailey, Johnson, Fogg, & Friese, ; Morgan et al., ; Williams et al., ). Two studies focussed on adults, and one on children up to age 5.…”

Section: Resultsmentioning

confidence: 99%

“…The more methodologically robust of the two adult papers reported that adults are more likely to be admitted for medical and dental reasons, and less likely for surgical reasons (Morgan et al., ). The other adult study did not report data in a comparable way, including only the five most common discharge diagnoses, all of which were medical reasons, and mostly more common in the group with intellectual disabilities (Ailey et al., ). Children with intellectual disabilities were more likely to be admitted than were the comparison group for numerous medical reasons, but not so for disorders of the oral cavity.…”

Section: Resultsmentioning

confidence: 99%

Hospital admissions for physical health conditions for people with intellectual disabilities: Systematic review

Dunn

Hughes-McCormack

Cooper

2017

Research Intellect Disabil

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“…There are three other large-scale studies [139][140][141] on hospitalisations of adults with ID that we are aware of, but none differentiated between emergency and planned admissions. Our focus on preventable emergency admissions means that any comparison is difficult, as we would not expect good primary care management to decrease planned admissions for ACSCs.…”

Section: Mortalitymentioning

confidence: 99%

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

Carey

Hosking

Harris

et al. 2017

Health Serv Deliv Res

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Background People with intellectual disability (ID) have poorer health than the general population; however, there is a lack of comprehensive national data describing their health-care needs and utilisation. Annual health checks for adults with ID have been incentivised through primary care since 2009, but only half of those eligible for such a health check receive one. It is unclear what impact health checks have had on important health outcomes, such as emergency hospitalisation. Objectives To evaluate whether or not annual health checks for adults with ID have reduced emergency hospitalisation, and to describe health, health care and mortality for adults with ID. Design A retrospective matched cohort study using primary care data linked to national hospital admissions and mortality data sets. Setting A total of 451 English general practices contributing data to Clinical Practice Research Datalink (CPRD). Participants A total of 21,859 adults with ID compared with 152,846 age-, gender- and practice-matched controls without ID registered during 2009–13. Interventions None. Main outcome measures Emergency hospital admissions. Other outcomes – preventable admissions for ambulatory care sensitive conditions, and mortality. Data sources CPRD, Hospital Episodes Statistics and Office for National Statistics. Results Compared with the general population, adults with ID had higher levels of recorded comorbidity and were more likely to consult in primary care. However, they were less likely to have long doctor consultations, and had lower continuity of care. They had higher mortality rates [hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.3 to 3.9], with 37.0% of deaths classified as being amenable to health-care intervention (HR 5.9, 95% CI 5.1 to 6.8). They were more likely to have emergency hospital admissions [incidence rate ratio (IRR) 2.82, 95% CI 2.66 to 2.98], with 33.7% deemed preventable compared with 17.3% in controls (IRR 5.62, 95% CI 5.14 to 6.13). Health checks for adults with ID had no effect on overall emergency admissions compared with controls (IRR 0.96, 95% CI 0.87 to 1.07), although there was a relative reduction in emergency admissions for ambulatory care-sensitive conditions (IRR 0.82, 95% CI 0.69 to 0.99). Practices with high health check participation also showed a relative fall in preventable emergency admissions for their patients with ID, compared with practices with minimal participation (IRR 0.73, 95% CI 0.57 to 0.95). There were large variations in the health check-related content that was recorded on electronic records. Limitations Patients with milder ID not known to health services were not identified. We could not comment on the quality of health checks. Conclusions Compared with the general population, adults with ID have more chronic diseases and greater primary and secondary care utilisation. With more than one-third of deaths potentially amenable to health-care interventions, improvements in access to, and quality of, health care are required. In primary care, better continuity of care and longer appointment times are important examples that we identified. Although annual health checks can also improve access, not every eligible adult with ID receives one, and health check content varies by practice. Health checks had no impact on overall emergency admissions, but they appeared influential in reducing preventable emergency admissions. Future work No formal cost-effectiveness analysis of annual health checks was performed, but this could be attempted in relation to our estimates of a reduction in preventable emergency admissions. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Hospitalizations of Adults With Intellectual Disability in Academic Medical Centers

Cited by 23 publications

References 14 publications

Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England

Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England

Hospital admissions for physical health conditions for people with intellectual disabilities: Systematic review

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

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