Date Presented 04/01/2022
Individuals with intellectual and developmental disabilities (IDD) have poorer health outcomes than those without IDD, in part because of a lack of training for health care professionals. Researchers implemented a training program for emergency department staff aimed at improving recognition, documentation, and coding. Results indicate that training was considered useful by staff but did not result in coding changes. Recommendations for future research and continued efforts are made.
Primary Author and Speaker: Molly Bathje
Additional Authors and Speakers: Sarah Brennan, Rose F. DiGiulio, Maeve McCormack, Marisa Snyder
BACKGROUND: Individuals with intellectual and developmental disabilities (IDD) have poorer health outcomes and shorter life expectancies than those without. Lack of training for healthcare professionals working with individuals with IDD contributes to poorer health outcomes. One of the outcomes of this lack of knowledge is that an IDD diagnosis can go undocumented in the patient’s health record, impacting the allocation of effective, coordinated care and reimbursement. Individuals with IDD utilize the emergency room at higher rates than those without IDD and their hospital stays most often initiate in the emergency department (ED). The aim of this study was to investigate the efficacy of a training module for Emergency Department (ED) personnel at an academic medical center to increase identification and documentation of IDD as a secondary diagnosis.
DESIGN: The pre:-post research design included providing a online training module to ED providers (n = 94) including nursing staff (48%), physicians and other advanced practitioners (39%), students (6%), and patient support staff (6%).
METHOD: The online training module was developed by graduate nursing and occupational therapy students with input from expert faculty members. A pre and post survey of knowledge, behaviors and beliefs about documenting IDD was administered. Descriptive analysis of the survey results along with Wilcoxon signed rank tests were conducted to identify the impact of the training on providers’ perceived ability to identify and document IDD. Emergency Department data on the number of visits that included an IDD diagnosis was collected for a three month period before and after the training and were analyzed using t-tests to identify changes in documentation and billing.
RESULTS: Results indicate that 70% of participants never received training on identification and documentation of IDD, and 74% of participants reported the training was helpful. Increases in participants’ confidence in ability to identify (z = -4.42, p = 0.00, r = -.57) and document (z = -4.21, p = 0.00, r = -.73) IDD, and heir belief that documenting IDD impacts hospital finances (z = -6.03, p = 0.00, r = .62) were noted between pre and post-test. There was no significant difference in perceived overall importance of documentation of IDD. There was no significant change in the percentage of patients with a diagnosis of IDD before and after the training.
CONCLUSION: These results confirm a lack of training for healthcare professionals regarding IDD. Prior to training, participants understood the identification of people with IDD as an important issue but lacked specific knowledge about why and how to document. Although the final coding of IDD did not increase after training, this results may indicate that additional training of coding staff is an important aspect to consider. Results of this study indicate potential for use of an online training as a means for increasing identification and documentation in the ED which could ultimately improve health outcomes. This study exemplifies the important role that occupational therapy practitioners can take in advocacy for health equity for individuals with IDD and the role of occupational therapy within interdisciplinary teams addressing health disparities.
References
Bathje, M., Conrad, S., Medick, M., Ross, M. & Fogg, L. (2021). Differences in hospital-based care for patient with intellectual and developmental disabilities. American Journal of Occupational Therapy, 75(3), 7503180080. https://doi.org/10.5014/ajot.2021.046508
Krahn, G. (2019). A call for better data on prevalence and health surveillance of people with intellectual and developmental disabilities. Intellectual and developmental disabilities, 57(5), 357-375.
Reppermund, S., Srasuebekul, P., Dean, K., Trollor, J. (2019). Factors associated with death in people with intellectual disability. Journal of Applied Research in Intellectual Disabilities, 33. https://doi.org/10.1111/jar.12684
Vohra, R., Madhavan, S., Sambamoorthi, U. (2016). Emergency department use among adults with autism spectrum disorders (ADS). Journal of Autism and Developmental Disorders, 46, 1441-1445. https://doi.org/10.1007/s10803-015-2692-2
