Factors associated with ambulatory care sensitive emergency department visits for South Carolina Medicaid members with intellectual disability.
S McDermott, J Royer, J R Mann and 1 others
PMID 29027297WHAT IT FOUND
Medicaid adults with mild or unspecified intellectual disability and those living at home without health support had more emergency visits for conditions that often can be managed without emergency care; nursing home residents had more visits leading to hospital admission.
Key findings
01There were 106 919 emergency department visits, and 21 214 (19.8%) were for ambulatory care sensitive conditions; 82.9% of those visits were treated and discharged.
02Adults with mild or unspecified intellectual disability had the highest unadjusted overall emergency department and ambulatory care sensitive emergency department rates per member, while adults with Down syndrome or other genetic causes had the lowest ambulatory care sensitive rate per member.
03Compared with home without nursing or adult day health services, all three residential settings had 16.1% to 31.5% lower rates of ambulatory care sensitive emergency visits treated and discharged, while nursing home residence had a 38.1% higher rate of visits followed by hospital admission.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The analysis used administrative diagnosis codes, so intellectual disability status and subgroup could be misclassified. People with cerebral palsy, spina bifida or paralysis from spinal cord injury or stroke were excluded, so findings do not cover adults with those common comorbidities. Only adults aged 22 to 64 who were enrolled for at least 11 of 12 months were analysed, so children and intermittently enrolled adults are not represented. The study did not measure the specific supports or services each person received in community or home settings, so it cannot explain why emergency visit rates differed by residential setting. Some emergency visits coded as ambulatory care sensitive may have involved conditions that were not actually preventable with outpatient care. Only emergency department data were used, not admissions that did not start in the emergency department, so it is an incomplete picture of ambulatory care sensitive hospital use. Findings are from South Carolina Medicaid members from 2001 to 2011 and may not generalise to other states, insurance systems or periods. This was an observational claims analysis; it reports associations, not proof that changing residential support or primary care access caused the emergency visit differences.
Declared interests
The study was funded by the Centers for Disease Control, National Center on Birth Defects and Developmental Disabilities, in partnership with the Association of University Centers on Disability. The supplied text does not report author conflicts of interest.
The easy way to misread this
Do not read the higher emergency department rates for adults with intellectual disability living at home without health support as proof that adding support would prevent visits. This was an observational claims analysis, and the authors could not determine why rates varied across residential settings.