Repeat Emergency Department Visits for Individuals With Intellectual and Developmental Disabilities and Psychiatric Disorders

Abstract Although individuals with intellectual and developmental disabilities (IDD) and psychiatric concerns are more likely than others to visit hospital emergency departments (EDs), the frequency of their returns to the ED within a short time is unknown. In this population-based study we examined the likelihood of this group returning to the ED within 30 days of discharge and described these visits for individuals with IDD + psychiatric disorders (n = 3,275), and persons with IDD only (n = 1,944) compared to persons with psychiatric disorders only (n = 41,532). Individuals with IDD + psychiatric disorders, and individuals with IDD alone were more likely to make 30-day repeat ED visits. Improving hospital care and postdischarge community linkages may reduce 30-day returns to the ED among adults with IDD.

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The impact of COVID-19 on hospital admissions and emergency department visits: A population-based study

PLoS ONE ◽

10.1371/journal.pone.0252441 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252441

Author(s):

Elissa Rennert-May ◽

Jenine Leal ◽

Nguyen Xuan Thanh ◽

Eddy Lang ◽

Shawn Dowling ◽

...

Keyword(s):

Public Health ◽

Emergency Department ◽

Hospital Admissions ◽

Population Based ◽

Emergency Department Visits ◽

System Capacity ◽

Population Based Study ◽

Health Measures ◽

Ed Visits ◽

The Impact

Background As a result of the novel coronavirus disease 2019 (COVID-19), there have been widespread changes in healthcare access. We conducted a retrospective population-based study in Alberta, Canada (population 4.4 million), where there have been approximately 1550 hospital admissions for COVID-19, to determine the impact of COVID-19 on hospital admissions and emergency department (ED visits), following initiation of a public health emergency act on March 15, 2020. Methods We used multivariable negative binomial regression models to compare daily numbers of medical/surgical hospital admissions via the ED between March 16-September 23, 2019 (pre COVID-19) and March 16-September 23, 2020 (post COVID-19 public health measures). We compared the most frequent diagnoses for hospital admissions pre/post COVID-19 public health measures. A similar analysis was completed for numbers of daily ED visits for any reason with a particular focus on ambulatory care sensitive conditions (ACSC). Findings There was a significant reduction in both daily medical (incident rate ratio (IRR) 0.86, p<0.001) and surgical (IRR 0.82, p<0.001) admissions through the ED in Alberta post COVID-19 public health measures. There was a significant decline in daily ED visits (IRR 0.65, p<0.001) including ACSC (IRR 0.75, p<0.001). The most common medical/surgical diagnoses for hospital admissions did not vary substantially pre and post COVID-19 public health measures, though there was a significant reduction in admissions for chronic obstructive pulmonary disease and a significant increase in admissions for mental and behavioral disorders due to use of alcohol. Conclusions Despite a relatively low volume of COVID-19 hospital admissions in Alberta, there was an extensive impact on our healthcare system with fewer admissions to hospital and ED visits. This work generates hypotheses around causes for reduced hospital admissions and ED visits which warrant further investigation. As most publicly funded health systems struggle with health-system capacity routinely, understanding how these reductions can be safely sustained will be critical.

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Postpartum emergency department use among women with intellectual and developmental disabilities: a retrospective cohort study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2018-211589 ◽

2019 ◽

Vol 73 (6) ◽

pp. 557-563 ◽

Cited By ~ 2

Author(s):

Monika Mitra ◽

Ilhom Akobirshoev ◽

Susan L Parish ◽

Anne Valentine ◽

Karen M Clements ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Emergency Department ◽

Developmental Disabilities ◽

Postpartum Period ◽

Post Partum ◽

Population Based ◽

Intellectual And Developmental Disabilities ◽

Healthcare Needs ◽

Ed Visits

BackgroundAn emerging body of evidence underscores the often-intensive perinatal healthcare needs of women with intellectual and developmental disabilities (IDD). However, population-based research examining postpartum experiences of US women with IDD is sparse. We examined emergency department (ED) use in the postpartum period among Massachusetts mothers with IDD.MethodsWe analysed 2002–2010 Massachusetts Pregnancy to Early Life Longitudinal data to compare any and ≥2 ED visits between mothers with and without IDD: within 1–42 days post partum, 1–90 days post partum and 1–365 days post partum. We also determined whether or not such ED use was non-urgent or primary-care sensitive.ResultsWe identified 776 births in women with IDD and 595 688 births in women without IDD. Across all three postpartum periods, women with IDD were vastly more likely to have any postpartum ED use, to have ≥2 ED visits and to have ED visits for mental health reasons. These findings persisted after controlling for numerous sociodemographic and clinical characteristics. Women with IDD were less likely to have non-urgent ED visits during the three postpartum periods and they were less likely to have primary-care sensitive ED visits during the postpartum period.ConclusionThese findings contribute to the emerging research on perinatal health and healthcare use among women with IDD. Further research examining potential mechanisms behind the observed ED visit use is warranted. High ED use for mental health reasons among women with IDD suggests that their mental health needs are not being adequately met.

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High health care costs among adults with intellectual and developmental disabilities: a population-based study

Journal of Intellectual Disability Research ◽

10.1111/jir.12554 ◽

2018 ◽

Vol 63 (2) ◽

pp. 124-137 ◽

Cited By ~ 8

Author(s):

Y. Lunsky ◽

C. De Oliveira ◽

A. Wilton ◽

W. Wodchis

Keyword(s):

Health Care ◽

Developmental Disabilities ◽

Health Care Costs ◽

Population Based ◽

Intellectual And Developmental Disabilities ◽

Population Based Study ◽

Care Costs

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Morbidity and mortality of women and men with intellectual and developmental disabilities newly initiating antipsychotic drugs

BJPsych Open ◽

10.1192/bjpo.bp.116.002691 ◽

2016 ◽

Vol 2 (2) ◽

pp. 188-194 ◽

Cited By ~ 4

Author(s):

Simone N. Vigod ◽

Yona Lunsky ◽

Virginie Cobigo ◽

Andrew S. Wilton ◽

Sarah Somerton ◽

...

Keyword(s):

Venous Thromboembolism ◽

Developmental Disabilities ◽

Antipsychotic Drugs ◽

Population Based ◽

Intellectual And Developmental Disabilities ◽

Medical Outcomes ◽

Population Based Study ◽

Antipsychotic Medications ◽

Men And Women

BackgroundWhile up to 45% of individuals with intellectual and developmental disabilities (IDD) have a comorbid psychiatric disorder, and antipsychotics are commonly prescribed, gender differences in the safety of antipsychotics have rarely been studied in this population.AimsTo compare men and women with IDD on medical outcomes after antipsychotic initiation.MethodOur population-based study in Ontario, Canada, compared 1457 women and 1951 men with IDD newly initiating antipsychotic medication on risk for diabetes mellitus, hypertension, venous thromboembolism, myocardial infarction, stroke and death, with up to 4 years of follow-up.ResultsWomen were older and more medically complex at baseline. Women had higher risks for venous thromboembolism (HR 1.72, 95% CI 1.15–2.59) and death (HR 1.46, 95% CI 1.02–2.10) in crude analyses; but only thromboembolism risk was greater for women after covariate adjustment (aHR 1.58, 95% CI 1.05–2.38).ConclusionsGender should be considered in decision-making around antipsychotic medications for individuals with IDD.

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Antipsychotic Use With and Without Comorbid Psychiatric Diagnosis Among Adults with Intellectual and Developmental Disabilities

The Canadian Journal of Psychiatry ◽

10.1177/0706743717727240 ◽

2017 ◽

Vol 63 (6) ◽

pp. 361-369 ◽

Cited By ~ 18

Author(s):

Yona Lunsky ◽

Wayne Khuu ◽

Mina Tadrous ◽

Simone Vigod ◽

Virginie Cobigo ◽

...

Keyword(s):

Developmental Disabilities ◽

Antipsychotic Medication ◽

Psychiatric Diagnosis ◽

Group Homes ◽

Population Based ◽

Intellectual And Developmental Disabilities ◽

Psychiatric Condition ◽

Population Based Study ◽

Drug Benefits ◽

Appropriate Prescribing

Objective: Antipsychotic use is controversial in the management of adults with intellectual and developmental disabilities (IDD) because of inconclusive evidence for efficacy in the absence of a comorbid psychiatric condition, and substantial concerns about adverse effects. We aimed to characterize antipsychotic use among Ontario adults with IDD and compare profiles of those with and without a documented psychiatric diagnosis. Method: This population-based study included 51,881 adults with IDD under 65 y as of April 2010 receiving provincial drug benefits in Ontario who were followed until March 2016 to identify those dispensed at least one antipsychotic medication. Profiles of those with and without a psychiatric diagnosis were compared. Results: Overall, 39.2% of adults ( n = 20,316) were dispensed an antipsychotic medication, which increased to 56.4% in a subcohort residing in group homes. Almost one-third (28.91%) of people prescribed an antipsychotic medication did not have a documented psychiatric diagnosis. Those without a psychiatric diagnosis differed considerably from those with a diagnosis. In particular, those without a psychiatric diagnosis were older, less likely to have used antidepressants or benzodiazepines in the year before, and less likely to have used ambulatory and acute care. Conclusions: Antipsychotic use in IDD is common, and occurs frequently without a psychiatric diagnosis. Attention toward how antipsychotics are prescribed and monitored for people with IDD in Canada is warranted to ensure appropriate prescribing.

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Health and service use of newcomers and other adults with intellectual and developmental disabilities: A population‐based study

Journal of Applied Research in Intellectual Disabilities ◽

10.1111/jar.12856 ◽

2021 ◽

Author(s):

Anna Durbin ◽

James K. H. Jung ◽

Hannah Chung ◽

Elizabeth Lin ◽

Robert Balogh ◽

...

Keyword(s):

Developmental Disabilities ◽

Service Use ◽

Population Based ◽

Intellectual And Developmental Disabilities ◽

Population Based Study

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Evidence for racial/ethnic disparities in emergency department visits following breast cancer surgery among women in California: a population-based study

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06119-5 ◽

2021 ◽

Author(s):

Mary Falcone ◽

Lihua Liu ◽

Albert Farias ◽

JuanJuan Zhang ◽

Irene Kang ◽

...

Keyword(s):

Breast Cancer ◽

Emergency Department ◽

Ethnic Disparities ◽

Population Based ◽

Cancer Surgery ◽

Emergency Department Visits ◽

Breast Cancer Surgery ◽

Population Based Study ◽

Racial Ethnic

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Huntington’s Disease in Israel: A Population-based Study Using 20 Years of Routinely-Collected Healthcare Data

Journal of Huntington s Disease ◽

10.3233/jhd-210500 ◽

2021 ◽

pp. 1-9

Author(s):

Natalie Gavrielov-Yusim ◽

Yael Barer ◽

Michael Martinec ◽

Athanasios Siadimas ◽

Spyros Roumpanis ◽

...

Keyword(s):

Huntington's Disease ◽

Huntington’S Disease ◽

Healthcare Utilization ◽

Behavioral Problems ◽

Clinical Manifestations ◽

Population Based ◽

Emergency Department Visits ◽

Study Cohort ◽

Population Based Study ◽

Healthcare Data

Background: Huntington’s disease (HD) is a rare, genetic, neurodegenerative disease. Obtaining population-level data on epidemiology and disease management is challenging. Objective: To investigate the epidemiology, clinical manifestations, treatment, and healthcare utilization of patients with HD in Israel. Methods: Retrospective population-based cohort study, including 20 years of routinely collected data from Maccabi Healthcare Services, an insurer and healthcare provider for one-quarter of the Israeli population. Results: The study cohort included 109 adult patients (aged ≥18 years) diagnosed with HD, with mean age of 49.9 years and 56%females. The most common HD-related conditions were anxiety (40%), behavioral problems (34%), sleep disorders (21%), and falls (13%). Annual incidence rates for HD ranged from 0.17 to 1.34 per 100,000 from 2000 to 2018; the 2018 crude prevalence in adults was 4.36 per 100,000. Median survival from diagnosis was approximately 12 years (95%CI: 10.4–15.3). The most frequent symptomatic treatments were antidepressants (69%), antipsychotics (63%), and tetrabenazine (63%), the only drug approved for the treatment of HD chorea in Israel during the examined period. Patterns of healthcare utilization changed as disease duration increased, reflected by increased frequency of emergency department visits and home visits. Conclusion: This retrospective population-based study provides insights into the prevalence, incidence, clinical profile, survival, and resource utilization of patients with HD in ethnically diverse Israel. The findings in this study are generally consistent with the international literature and demonstrate the value of routinely collected healthcare data as a complementary resource in HD research.

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