Emergency Department Use for People with Intellectual and Developmental Disabilities

Preventable emergency department (ED) visits are defined using a range of methodologies in recent analyses of the U.S health system. Understanding preventable use may be particularly important for vulnerable populations, such as people with intellectual and developmental disability (I/DD).  However, differences in utilization patterns combined with complex care needs and communication challenges suggest that modified definitions may be required for the I/DD  population.  Recent analyses of more than 18,000 Massachusetts adults with I/DD receiving state residential or individual supports identified less frequent (80%) ED use than the general population with less frequent utilization due to falls (RR=0.56), the top cause for both populations, but more frequent utilization due to seizures (RR=5.6), urinary tract infections (RR=1.8) and feeding tube complications.

This two-phase study 1) defines avoidable emergency department visits specifically for people with I/DD, and 2) assesses these patterns of utilization using multiple data sources.  Existing definitions, published literature and clinical and multi-disciplinary input will be used to define preventable utilization using the ICD-9 diagnostic and procedure codes available in ED claims data and in hospital discharge data for ED use that results in inpatient admissions.  The resultant definition will be applied to de-identified state disability data and Medicaid data to assess performance of the definition and resultant patterns. Results will presented as well as recommendations for strategic improvements in service delivery and health policy for people with I/DD.  Methods and results have applicability for other states interested in estimating and benchmarking preventable emergency department utilization for this population.