Abstract
This study describes adults with IDD in acute-care hospital settings and identifies differences in their experience compared to patients without IDD. Comparisons between the two samples showed differences in the length of stay, frequency to discharge environments, and number of OT visits per day. This study impacts the field of OT by increasing awareness of the utilization patterns of healthcare services for patients with IDD.
Primary Author and Speaker: Molly Bathje
Additional Authors and Speakers: Samantha Conrad, Matthew Medick, Molly Ross
Contributing Authors: Lou Fogg
The purpose of this research was to describe the population of adults with intellectual and developmental disabilities (IDD) in acute care hospital settings, and to explore how this population compares to adults without IDD and the related utilization of services and discharge placements. Life expectancy for people with IDD is increasing, therefore they experience similar age-related health conditions as those without IDD.2 Additionally, individuals with IDD are at higher risk for chronic health conditions such as orthopedic trauma.3 Adults with IDD represent a growing presence within healthcare environments, including in the acute care setting. Previous studies have identified that hospital lengths of stay and the number of medical interventions received are higher for individuals with IDD compared to those without.1 Occupational therapy (OT) practitioners are important members of the acute care hospital team, however no current research describes the IDD population in acute care settings as related to OT services. This retrospective study utilized descriptive and comparative analyses of acute care hospital medical records obtained from a national database. The database originates from a healthcare performance company that includes 50% of the nation’s acute care providers. Data was extracted from the database for patients over 18 years of age admitted from 1/2017-1/2019 with a primary diagnosis of a lower extremity orthopedic condition. From the initial extracted data, a sub-sample of patients with an IDD diagnosis were identified and an age-matched sample using a 1:3 ratio of IDD vs non-IDD patients was identified using stochastic matching. Descriptive statistics were conducted on the sample of patients with IDD and included age, gender, diagnosis, length of stay, number of OT treatments, payer, and discharge environment. Independent sample t-tests were conducted to compare average length of stay and OT treatments between the IDD and non-IDD samples. Chi square analyses were conducted to identify differences between samples for payer and discharge environments. Of 603,546 patients with orthopedic conditions in the database, 2,118 patients also had a diagnosis of IDD (n = .35%) and 6,354 patients without IDD were included in the matched sample. Within the IDD sample, the most common IDD diagnosis was unspecified intellectual disability (n = 1551). When comparing the two samples, the IDD sample experienced longer lengths of stay (t = -14.40, p < .01), were more likely to have Medicare coverage (χ2 (3) = 1170.38, p < .01), were more commonly discharged to subacute or skilled nursing facilities (χ2 (26) = 1099.8, p < .01), and received fewer OT charges per day (t = 4.50, p < .01) but more OT charges per hospitalization (t = -7.91, p < .01). Findings indicate that there is a difference in utilization patterns of individuals with IDD related to orthopedic conditions in acute care hospitals; however, OT services are being implemented for all patients regardless of IDD diagnosis. The differences in utilization patterns likely related to increased complexity of care for those with IDD. Although patients with an IDD diagnosis experience less OT services per day, they receive more services overall which is likely related to cognitive processing differences, impacting timeliness of progress toward goals. This is likely the reason the most common discharge environment is a skilled nursing facility, highlighting a need for OT practitioners to be able to respond to cognitive differences in both acute care and skilled nursing settings. This study highlights the differences in utilization patterns for patients with IDD and the need for OT practitioners to be adequately prepared to meet their needs in a variety of settings.
1. Glover, G., Williams, R., Tompkins, G., & Oyinlola, J. (2019). An observational study of the use of acute hospital care by people with intellectual disabilities in England. Journal of Intellectual Disability Research, 63(2), 85-99. https://doi.org/10.1111/jir.12544
2. Janicki, M. (2010). Aging adults with intellectual disabilities: Perspectives on emerging service concerns. Journal of Special Education and Rehabilitation, 11(1-2), 114-129. http://doi.org/10.5281/zenodo.28340
3. Jasien, J., Daimon, C. M., Maudsley, S., Shapiro, B. K., & Martin, B. (2012). Aging and bone health in individuals with developmental disabilities. International Journal of Endocrinology, 1–10. https://doi-org.ezproxy.rush.edu/10.1155/2012/469235