Time trends in emergency department use among adults with intellectual and developmental disabilities.
Willi Horner-Johnson, Stephan Lindner, Anna Levy and 13 others
PMID 34782255WHAT IT FOUND
Emergency department visits by adults with intellectual disabilities rose steadily from 2010 to 2016.
Full Medicaid expansion was associated with a slight decrease in these visits, while non-expansion states saw significant increases. Managed care transitions showed no clear effect on emergency use.
Key findings
01Total and outpatient emergency department visits increased significantly over the study period, with a linear trend coefficient of 0.48.
02States that fully expanded Medicaid saw a slight decrease in total and outpatient emergency visits, whereas non-expansion states experienced strong significant increases.
03Transitioning to managed care was not associated with differential trends in emergency department visits compared to states that did not transition.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study used a repeated cross-sectional design, meaning it looked at population groups at different times rather than tracking the same individuals, so changes in ED use might reflect changes in who was enrolled rather than changes in individual behavior. The analysis did not control for health characteristics such as comorbidities, which are major drivers of emergency use. Data on race and ethnicity were not available for all states, so these factors could not be controlled for. The sample was limited to eight states and excluded adults who also had Medicare, so the findings may not represent the broader US population of adults with IDD. Only one southern state was included, and it had not expanded Medicaid, which may have confounded the results regarding non-expansion states.
Declared interests
The study was reviewed and approved by the Medicaid agencies in each state. No specific funding source or author conflicts of interest are declared in the provided text.
The easy way to misread this
Do not assume that Medicaid expansion itself directly reduced emergency visits for individual patients. The study is cross-sectional, so the observed decrease in expansion states may reflect a change in the health profile of the people newly enrolling, rather than an improvement in care for existing patients.