Date Presented 04/05/19
Emergency room and hospital utilization among adults with IDD are significant contributors to rising healthcare costs. This study identified predictors of utilization for a sample of 597 adults with IDD. Using a retrospective survey of medical charts, logistic regressions were conducted. This study found risk factors unique to adults with IDD that should be addressed with tailored OT and primary-care interventions.
Primary Author and Speaker: Meghan Blaskowitz
PURPOSE: US Medicaid spending has increased 2-3% annually (Kaiser Family Foundation, 2015). Emergency room (ER) visits are consistently on the rise (Hernandez-Boussard et al., 2014), and ER and hospital utilization rates among people with intellectual and developmental disabilities (IDD) are significant contributors to rising healthcare costs (NYS DOH, n.d.). The Affordable Care Act identified a critical need to reduce these utilization rates. Understanding the risk factors that lead adults with IDD to utilize the ER/hospital can help occupational therapists (OT) provide targeted interventions aimed at decreasing over-utilization. Cost savings can then be redirected to more community-based service options for adults with IDD.
DESIGN: Participants (n=597) were drawn from adults with IDD who lived in group homes and supported apartments operated by a large nonprofit provider agency. Agency nurses were trained to complete a structured, retrospective survey of each participant’s medical chart and gather data on potential predictors of utilization including: age, sex, developmental disability, level of intellectual disability, chronic health problems, mental health diagnoses, polypharmacy, living arrangement, and region.
METHOD: Descriptive statistics, bivariate analyses and logistic regressions were conducted. Logistic regressions explored a variety of characteristics as independent predictors of: a) ER visits for medical reasons; b) hospital admission for medical reasons; c) ER visits for behavioral/psychiatric reasons; and d) hospital admission for behavioral/psychiatric reasons.
RESULTS: During the study period, 38% of the sample visited the ER for a medical issue, while 15% were admitted to the hospital. The rate of ER utilization for this sample was higher than the ER utilization rate (20%), but lower than the hospitalization rate (27%) in the US population (Gindi, Cohen & Kirzinger, 2012). Environmental factors that predicted ER utilization for a medical reason included residing in supported apartments (B = .951, OR = 2.59, p = .03) and in the poorest region, the Bronx (B=0.642, OR=1.901, p=0.076). The following individual-level characteristics were found to be predictive of ER utilization for a medical reason: each additional year of age (B = .019, OR = 1.02, p = .02); having cerebral palsy (B = .810, OR = 2.25, p = .01) or a neurological condition (B = .440, OR = 1.55, p = .05); each additional chronic condition (B = .121, OR = 1.13, p = .04); having a mental illness (B = .562, OR = 1.75, p = .01); and the use of five or more medications (polypharmacy) (B = .787, OR = 2.20, p = .01). Mental illness was the only significant predictor for ER utilization due to behavioral/psychiatric reasons (B = 2.931, OR = 18.75, p = .004). Age (B = .037, OR = 1.04, p = .001) and number of chronic conditions (B = .176, OR = 1.19, p = .02) were predictors of hospital admission, while no significant predictors of behavioral/psychiatric hospitalization were found.
CONCLUSION: Although these findings parallel utilization predictors in the general public, a number of risk factors were unique to this sample. Environmental factors uniquely contributed to increased utilization rates for this sample. These risk factors should be addressed with tailored OT and primary care interventions. As states across the nation transition to Medicaid managed care, the unique qualities of adults with IDD must be considered in setting capitation rates. OTs can be a vital part of implementing self-management programs for adults with IDD who live in supported apartments or independent living settings. Further investigation is needed to determine the impact of policy and practice-level interventions on the utilization and health-related quality of life of adults with IDD.
References
Gindi, R.M., Cohen, R.A., & Kirzinger, W.K. (2012). Emergency room use among adults aged 18-64: Early release of estimates from the National Health Interview Survey, January-June 2011. Hyattsville, MD: National Center for Health Statistics.
Hernandez-Boussard, T., Burns, C.S., Wang, N.E., Baker, L.C., & Goldstein, B.A. (2014). The Affordable Care Act reduces emergency department use by young adults: Evidence from three states. Health Affairs, 33(9), 1648–1654. https://doi.org/10.1377/hlthaff.2014.0103.
Kaiser Family Foundation. (2015). Medicaid enrollment and spending growth: FY 2015 & 2016. Retrieved from http://kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2015-2016/.
New York State Department of Health (NYS DOH). (n.d.). New York’s Pathway to Achieving the Triple Aim: Better Care, Better Health, Lower Costs: Reducing Avoidable Hospital Use through Delivery System Reform. Retrieved from https://www.health.ny.gov/health_care/medicaid/redesign/docs/ny_mrt_dsrip_reducing_avoid_hosp_use.pdf.
