High outpatient visits among people with intellectual disabilities caring in a disability institution in Taipei: a 4-year survey.
One-third of institutionalized adults with ID rack up over 25 outpatient visits a year, but behavioral rehearsals and better screening can trim the load.
01Research in Context
What this study did
Staff at a large disability center in Taipei counted every outpatient visit for the adults with intellectual disability. They looked back at four full years of medical records. No one was left out.
The goal was simple: see how often this group sees doctors and if a few people drive most of the trips.
What they found
One in three adults averaged more than 25 clinic visits every year. This small group used over half of all the appointments.
In other words, 29 percent of the people created 54 percent of the traffic.
How this fits with other research
Capio et al. (2013) followed young adults with Down syndrome and also saw heavy care use. They linked the load to kids who never fully switched from pediatric to adult doctors. Jin-Ding’s crowd stayed in one center, so the hand-off gap can’t explain the numbers. The new clue: high use can happen even when the same place coordinates care.
Mammarella et al. (2022) cut dental visits for adults with ID by teaching mock-chair skills. Nearly half who used to need sedation now cope without it. Their result flips the Taipei picture: instead of accepting lots of trips, you can train clients and drop the count.
MacRae et al. (2015) add another layer. Their review shows diabetes is common but usually missed in people with ID. Untreated diabetes could be one hidden engine behind the Taipei surge. Together the papers point to the same fix: screen better, teach skills, and visits should fall.
Why it matters
If you serve adults with ID, expect a small slice to eat most of your medical budget. Flag anyone with more than two visits a month, run fresh health screens, and add brief behavioral rehearsals like C et al. did for dental care. You may prevent the problem that Jin-Ding caught too late.
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02At a glance
03Original abstract
Few studies reported in the literature have addressed the long-term trend of the use of medical care for people with intellectual disabilities (ID) in institutions. The subject cohort in this study was made of 168 individuals with ID in a public residential facility from 1999 to 2002 in Taipei, Taiwan. The average age of participants was 19.3 years, and their average stay in an institution was 6.6 years. The average annual outpatient visit of the study participants was 18.2 in the previous 4 years. It was found that they had more medical visits than the general population. Nearly 20.8-34.5% (average 29.0%) of the participants utilized more than 25 visits annually which was defined as high outpatient visit users. This group of high outpatient users consumed more than half of the total annual outpatient care visits in the past 4 years. In the full model of Generalized Estimating Equations to compare the high and non-high outpatient users, the factor of individuals with ID dwelling in the institution were more likely to be high outpatient care users than individuals who were only accepting institutional day care services (OR=6.29, 95% CI=1.35-29.30). The present study provides general information of high outpatient utilization and its determinants of people with ID and provides evidence for medical care decision makers dealing with policy development for people with ID care in institutions.
Research in developmental disabilities, 2007 · doi:10.1016/j.ridd.2005.12.003