Time trends in emergency department use among adults with intellectual and developmental disabilities.
Developmental disabilities
Emergency departments
Health policy
Intellectual disability
Medicaid
Journal
Disability and health journal
ISSN: 1876-7583
Titre abrégé: Disabil Health J
Pays: United States
ID NLM: 101306633
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
22
06
2021
revised:
21
09
2021
accepted:
14
10
2021
pubmed:
17
11
2021
medline:
7
4
2022
entrez:
16
11
2021
Statut:
ppublish
Résumé
Emergency Department (ED) visits are common among adults with intellectual and developmental disabilities (IDD). However, little is known about how ED use has varied over time in this population, or how it has been affected by recent Medicaid policy changes. To examine temporal trends in ED use among adult Medicaid members with IDD in eight states that ranged in the extent to which they had implemented state-level Medicaid policy changes that might affect ED use. We conducted repeated cross-sectional analyses of 2010-2016 Medicaid claims data. Quarterly analyses included adults ages 18-64 years with IDD (identified by diagnosis codes) who were continuously enrolled in Medicaid for the past 12 months. We assessed change in number of ED visits per 1000 member months from 2010 to 2016 overall and interacted with state level policy changes such as Medicaid expansion. States with no Medicaid expansion experienced an increase in ED visits (linear trend coefficient: 1.13, p < 0.01), while states operating expansion via waiver had a much smaller (non-significant) increase, and states with ACA-governed expansion had a decrease in ED visits (linear trend coefficient: 1.17, p < 0.01). Other policy changes had limited or no association with ED visits. Medicaid expansion was associated with modest reduction or limited increase in ED visits compared to no expansion. We found no consistent decrease in ED visits in association with other Medicaid policy changes.
Sections du résumé
BACKGROUND
Emergency Department (ED) visits are common among adults with intellectual and developmental disabilities (IDD). However, little is known about how ED use has varied over time in this population, or how it has been affected by recent Medicaid policy changes.
OBJECTIVE
To examine temporal trends in ED use among adult Medicaid members with IDD in eight states that ranged in the extent to which they had implemented state-level Medicaid policy changes that might affect ED use.
METHODS
We conducted repeated cross-sectional analyses of 2010-2016 Medicaid claims data. Quarterly analyses included adults ages 18-64 years with IDD (identified by diagnosis codes) who were continuously enrolled in Medicaid for the past 12 months. We assessed change in number of ED visits per 1000 member months from 2010 to 2016 overall and interacted with state level policy changes such as Medicaid expansion.
RESULTS
States with no Medicaid expansion experienced an increase in ED visits (linear trend coefficient: 1.13, p < 0.01), while states operating expansion via waiver had a much smaller (non-significant) increase, and states with ACA-governed expansion had a decrease in ED visits (linear trend coefficient: 1.17, p < 0.01). Other policy changes had limited or no association with ED visits.
CONCLUSIONS
Medicaid expansion was associated with modest reduction or limited increase in ED visits compared to no expansion. We found no consistent decrease in ED visits in association with other Medicaid policy changes.
Identifiants
pubmed: 34782255
pii: S1936-6574(21)00198-9
doi: 10.1016/j.dhjo.2021.101225
pmc: PMC10950032
mid: NIHMS1971042
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
101225Subventions
Organisme : Intramural CDC HHS
ID : CC999999
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Références
N Engl J Med. 2015 Feb 5;372(6):537-45
pubmed: 25607243
Med Care. 2017 Jun;55(6):576-582
pubmed: 28221275
Med Care. 2020 Sep;58(9):826-832
pubmed: 32826747
Milbank Q. 2019 Jun;97(2):583-619
pubmed: 30957294
Ann Emerg Med. 2021 Jan;77(1):76-81
pubmed: 32854964
Intellect Dev Disabil. 2019 Aug;57(4):289-306
pubmed: 31373550
JAMA Intern Med. 2016 Oct 01;176(10):1501-1509
pubmed: 27532694
Med Care. 2019 Feb;57(2):101-108
pubmed: 30461581
PLoS One. 2017 Aug 3;12(8):e0182346
pubmed: 28771602
Front Public Health. 2014 Sep 24;2:160
pubmed: 25309896
Am J Intellect Dev Disabil. 2018 Jul;123(4):371-381
pubmed: 29949427
Health Aff (Millwood). 2016 Aug 1;35(8):1480-6
pubmed: 27503974
J Ambul Care Manage. 2021 Apr-Jun 01;44(2):138-147
pubmed: 33492884
Am J Public Health. 2018 Sep;108(9):1235-1237
pubmed: 30024794
Disabil Health J. 2019 Jul;12(3):403-410
pubmed: 30765256
J Intellect Disabil Res. 2018 Mar;62(3):165-178
pubmed: 29027297
Ann Emerg Med. 2017 Aug;70(2):215-225.e6
pubmed: 28641909
Health Econ. 2016 May;25(5):529-42
pubmed: 25728285
Front Public Health. 2014 Jul 15;2:83
pubmed: 25077139
Am J Emerg Med. 2020 Dec;38(12):2586-2590
pubmed: 31982222
J Appl Res Intellect Disabil. 2014 Sep;27(5):431-46
pubmed: 23913632
JAMA Netw Open. 2019 Jul 3;2(7):e197136
pubmed: 31314115
Health Aff (Millwood). 2017 Aug 1;36(8):1485-1488
pubmed: 28784742
JAMA Netw Open. 2020 Jul 1;3(7):e208776
pubmed: 32648922
Intellect Dev Disabil. 2012 Jun;50(3):243-50
pubmed: 22731973
JAMA Intern Med. 2017 Apr 1;177(4):538-545
pubmed: 28192568
Ann Emerg Med. 2017 Nov;70(5):607-614.e1
pubmed: 28751087