Predictors and outcomes of recognition of intellectual disability for adults during hospital admissions: A retrospective data linkage study in NSW, Australia

Abstract

Adults with intellectual disability have high health care needs. Despite frequent contact with health services, they often receive inadequate health care. One method to improve health care delivery is reasonable adjustments, that is, the adaptation of health care delivery such that barriers to participation are removed for the person with disability. A starting point for the provision of reasonable adjustments is recognition of intellectual disability during the health care contact. To determine rates and predictors of the recognition of intellectual disability during hospital admissions, and its impact on admission metrics, we examined a population of adults with intellectual disability identified from disability services datasets from New South Wales, Australia between 2005 and 2014. Recognition of intellectual disability was determined by the recording of an International Classification of Diseases 10th revision (ICD-10) diagnostic code for intellectual disability during a given hospital admission. We examined how recognition of intellectual disability related to length of hospital episodes. We found an overall low rate of recognition of intellectual disability (23.79%) across all hospital episodes, with the proportion of hospital episodes recognising intellectual disability decreasing from 2005–2015. Admissions for adults with complex health profiles (e.g., those with many comorbidities, those with Autism Spectrum Disorder, and those admitted for urgent treatment) were more likely to recognise intellectual disability, but admissions for adults with complexity in other domains (i.e., for those in custody, or those with drug and alcohol disorders) were less likely to recognise intellectual disability. Recognition of intellectual disability was associated with longer episodes of care, possibly indicating the greater provision of reasonable adjustments. To improve the recognition of intellectual disability for adults during health service contacts, we advocate for the implementation of targeted initiatives (such as a nationwide disability flag to be included in health service records) to improve the provision of reasonable adjustments.

Recording of intellectual disability in general hospitals in England 2006–2019: Cohort study using linked datasets

“…Analysis of factors associated with unrecorded diagnosis showed that having a less severe intellectual disability was independently associated with increased likelihood of intellectual disability never being recorded in general hospital data, in keeping with previous research [ 37 ]. Mild intellectual disability may not be immediately obvious on meeting a person with the condition and specific enquiry may not be included in standard medical admission assessments.…”

“…There is no English benchmark against which the results of this study can be directly compared, although data suggest that low levels of recording of intellectual disability in healthcare records is an international issue. A recent study conducted in New South Wales, Australia, found an overall recognition of intellectual disability in only 23.79% of hospital admissions of adults with the condition and that recording had reduced over time [ 37 ]. A further Australian study that investigated the recording of intellectual disability in children showed that hospital data identified only 14% those with intellectual disability who had been admitted [ 38 ].…”

“…found an overall recognition of intellectual disability in only 23.79% of hospital admissions of adults with the condition and that recording had reduced over time [37]. A further Australian study that investigated the recording of intellectual disability in children showed that hospital data identified only 14% those with intellectual disability who had been admitted [38].…”

The influence of COVID-19 barrier measures on the positivity rate of typhoidal salmonellosis and amoebiasis in the Buea Health District, South West Region of Cameroon

“…Administrative authorization was also obtained from the District Health Service Buea, reference number F 1 Vol 2 /L/MINSANTE/RDPHSW/DHS/Buea/106a. Written formal permissions were obtained from heads of the ethics review committees of these health facilities in which they waived obtaining informed consent from patients to access data as has been done in other research works [12][13][14]. The data was collected anonymously and confidentiality was maintained by the non-identification of patients' information.…”

Intellectual and developmental disabilities in Ontario's criminal justice and forensic mental health systems: Using data to tell the story

“…For example, the 'Penrose hypothesis' was proposed in the UK to describe the increased number of people incarcerated following reductions in the number of psychiatry inpatient beds and has been used to illustrate how different parts of health care, social services and the criminal justice system are interconnected (Lamb, 2015;Wild et al, 2022). Policy documents from the US (Bronson et al, 2015;Concannon, 2019;Vallas, 2023), Australia (Rowe et al, 2017;Sharma, 2023) and the UK (Royal College of Psychiatrists, 2014;Warner, 2018;Williams & Braden, 2018) have highlighted concerns and called for changes in how care is provided to individuals with IDD both inside and outside of the system.…”