Health Care Utilization Patterns of Patients With Intellectual and Developmental Disabilities in the Acute-Care Setting

Within recent years, adults with intellectual and developmental disabilities (IDD) have experienced an increase in life expectancy and similar age-related illnesses as those without IDD (Janicki, 2010). Due to comorbid health conditions, adults with IDD are at a higher risk of fall-related traumatic injuries at a younger age (Cox et al., 2010). This population has thus become a growing presence in all healthcare environments, meaning medical professionals of all settings should be prepared to engage with patients with IDD. This is especially evident for occupational therapy (OT) practitioners of whom play an important role in acute care settings and have extensive education on working with the IDD population (Scaife et al., 2019). Therefore, the purpose of this research was to describe the population of adults with IDD in acute care hospital settings, and to explore how this population compares to healthcare utilization patterns of adults without IDD. Using a national database of acute care hospital data, this retrospective study conducted descriptive and comparative analyses of medical records for patients over 18 years of age admitted from 1/2017-12/2018 with a primary diagnosis of a lower extremity orthopedic condition or procedure. From the initial sample, a sub-population of patients with an IDD diagnosis was identified, along with a 3:1 age and gender-matched sample of patients without IDD. Descriptive statistics were identified for both samples to show means for age, gender, and top orthopedic and top IDD diagnosis. Independent sample t-tests were conducted to compare average length of stay and OT utilization between the two samples. Chi square analyses were conducted to identify differences between samples for payer and discharge environments. The samples experienced the same top three orthopedic diagnoses, suggesting that people with IDD experience similar orthopedic conditions to those without IDD. Despite this similarity, comparison of the two samples revealed that both groups experienced differences in hospital utilization patterns. The IDD sample experienced longer lengths of stay (t = -14.2, p < .001), were more likely to have Medicare coverage (χ² (3,8472) = 1170.38, p < .001), and were more commonly discharged to subacute or skilled nursing facilities (χ² (5,8472) = 1033.60, p < .001). Additionally, although occupational therapy services were implemented for all patients regardless of an IDD diagnosis, adults with IDD received fewer OT procedures per day (t = 4.50, p < .001) yet more OT visits per hospitalization (t = -7.91, p < .001). Findings of this study indicate that adults with IDD are experiencing differences in the delivery of healthcare services, particularly in their length of stay and discharge environment following an acute care hospitalization. These differences may be attributed to different health insurance providers, different complexity of care, presence of comorbid health conditions and/or preparedness of medical staff. This study suggests that occupational therapists should be leaders in adapting treatment protocols specifically for patients with IDD and to provide education to caregivers and healthcare providers on how to effectively communicate and work with this population.

References

Cox, C. R., Clemson, L., Stancliffe, R. J., Durvasula, S., & Sherrington, C. (2010). Incidence of and risk factors for falls among adults with an intellectual disability. Journal of Intellectual Disability Research, 54(12), 1045-1057.

Janicki, M. (2010). Aging adults with intellectual disabilities: Perspectives on emerging service concerns. Journal of Special Education and Rehabilitation, 11(1-2), 114-129. http://doi.org/10.5281/zenodo.28340.

Scaife, B. D., Lape, J. E., & Woods, S. (2019). Working with older adults with developmental and intellectual disabilities in long-term care. American Occupational Therapy Association, CE1-6.