Ambulatory Care Sensitive Conditions Among All-Payer Claimants With Intellectual and Developmental Disabilities.
People with IDD get hospitalized for preventable conditions at much higher rates regardless of insurance type.
01Research in Context
What this study did
Researchers looked at New Hampshire insurance claims from 2014-2016.
They compared hospital stays that could have been prevented with good outpatient care.
The sample included people with intellectual or developmental disabilities versus those without.
Both Medicaid and commercial insurance groups were studied.
What they found
People with IDD had more preventable hospital stays no matter their insurance type.
The gap was large and consistent across different medical conditions.
Medicaid and commercial insurance both showed the same pattern of worse outcomes.
How this fits with other research
Robertson et al. (2017) found dysphagia is common in severe ID - this helps explain why aspiration pneumonia hospitalizations might be preventable.
Lin et al. (2005) showed directors know preventive care is important but don't deliver it - the target paper proves this gap leads to actual hospitalizations.
Bigby et al. (2009) revealed poor medication documentation in residential settings - together these studies paint a picture of systemic healthcare quality issues across settings.
Yamaki et al. (2011) found more chronic conditions in disabled youth - the target extends this to show these conditions result in avoidable hospital stays.
Why it matters
Your clients with IDD are likely experiencing the same preventable hospitalizations. Start tracking which medical issues send them to the ER most often. Work with their medical team to create preventive care plans for those specific conditions. This could prevent hospital stays and keep clients in their homes and programs.
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02At a glance
03Original abstract
Inpatient hospitalizations for ambulatory care sensitive conditions (ACSC) among beneficiaries with and without intellectual and developmental disabilities (IDD) were examined using Medicaid and commercial claims from 2010-2014 in New Hampshire. IDD was defined with International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes using algorithms from the Centers for Medicare and Medicaid Services, and inpatient encounters were identified using the Healthcare Effectiveness Data and Information Set. In adjusted analyses, beneficiaries with IDD had more hospitalizations for ACSC than those without IDD in both insurance groups. Differences in patterns of ACSC prevalence, comorbidities, and hospital admissions between the commercially and Medicaid-insured groups show the value of using all-payer claims data, when possible, to understand health needs and health care utilization of insurance beneficiaries with IDD.
American journal on intellectual and developmental disabilities, 2021 · doi:10.1352/1944-7558-126.3.203