Ambulatory Care Sensitive Admissions in Individuals With Autism Spectrum Disorder, Intellectual Disability, and Population Controls.
Intellectual disability, not autism, drives twice-as-high rates of hospital stays that regular doctor visits could prevent.
01Research in Context
What this study did
The team pulled insurance records for three groups: people with autism only, people with intellectual disability with or without autism, and typical peers.
They counted "ambulatory care sensitive admissions" — hospital stays that regular doctor visits could have prevented.
Design was quasi-experimental: no random assignment, just large-scale number crunching.
What they found
Having intellectual disability doubled the risk of preventable hospital stays.
Autism alone did not raise the risk above typical levels.
The danger signal came from ID, not from ASD.
How this fits with other research
Hong et al. (2024) extend the same access-gap story to psychiatric emergency rooms: one-third of ASD/ID youths who need a psych bed are sent home because none exist.
Foley et al. (2018) map the front end of the problem — Australian GPs see more autistic children every year, but for psychosocial issues, not check-ups.
Together the three papers trace a clear path: primary-care visits shift toward crisis talk, preventable medical stays rise, and when things explode, emergency rooms lack beds.
Nordahl et al. (2016) offer a bright spot: with ABA shaping, kids with ASD and ID can finish MRIs without sedation — proof that tailored delivery works when we design it.
Why it matters
If your client has ID, schedule routine health visits before small issues grow. Teach families to ask for extended appointment times, picture schedules, or double visits. Flag common preventable conditions like dehydration, constipation, and pneumonia. Your behavior plan can include tolerating stethoscopes, blood-pressure cuffs, and swallowing pills so check-ups run smoothly. Better primary-care success today means fewer crisis hospital trips tomorrow.
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02At a glance
03Original abstract
Ambulatory care sensitive (ACS) admissions are those for which effective primary care can prevent the need for emergency department (ED) visits and inpatient hospitalizations, and are an indicator of primary care access. Individuals with autism spectrum disorder (ASD) and/or intellectual disability (ID) may be at higher risk for ACS admissions than individuals in the general population due to difficulty accessing primary care. The objective of this study was to compare the incidence of ACS admissions among four cohorts of individuals aged 2-24 years: ASD without co-occurring ID (ASD-only), ASD with co-occurring ID (ASD + ID), ID without ASD (ID-only), and population controls (PC). Data from ED visits and inpatient hospitalizations occurring between January 1, 2000 and December 31, 2015 were examined to identify ACS admissions. Generalized linear models were used to examine differences between cohorts on the number of ACS ED visits and inpatient hospitalizations. Results revealed the ASD + ID and ID-only cohorts had significantly higher rates of ACS inpatient hospitalizations than the PC cohort. Additionally, the ID-only cohort had higher rates of ACS ED visits than the PC cohort. The ASD-only and PC cohorts did not differ on incidence of ACS admissions. These findings suggest that presence of an ID with or without co-occurring ASD increased the risk for ACS inpatient hospitalizations, and presence of ID-only increased the risk for ACS ED visits. Future work should examine trajectories of ACS admissions over time and consider inclusion of additional characteristics that may elucidate reasons for differences in ACS admissions among these groups. Autism Res 2019, 12: 295-302 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Preventable hospitalizations are a common indicator of problems with access to quality primary healthcare. Findings of this study suggest that individuals with intellectual disability, with or without autism spectrum disorder, have higher rates of preventable hospitalizations than the general population. Further research is needed to understand how to improve access to primary care and reduce preventable hospitalizations for this vulnerable population.
Autism research : official journal of the International Society for Autism Research, 2019 · doi:10.1002/aur.2050