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NIH Report: Coordinated Care Can Address High Rates of Emergency Department Use by Disabled Adults

Authors recommend tailored prevention and primary care programs (Jan. 2)

Working-age adults with disabilities account for a disproportionately high proportion of annual emergency department visits, according to a comparison study by researchers at the National Institutes of Health (NIH).

One of the first detailed looks at this population’s increased use of urgent care, the NIH study — published online in Health Services Research — analyzed pooled data from the Medical Expenditure Panel Survey. The researchers found that restricted access to regular medical care, the complexity of the individual’s health profile, and the individual’s disability status contributed to the use of emergency department services by people with disabilities. To address this disparity, the authors recommend enhanced communication between emergency department and primary care physicians, and tailored prevention and primary care programs.

The study found that, despite representing 17% of the working-age U.S. population, adults with disabilities accounted for 39% of total emergency room visits. Those with a severely limiting disability visited an urgent care department more often than did their peers and were more likely to visit the department more than four times per year.

Emergency visits were also associated with poor access to primary medical care, which was more prevalent among adults with disabilities. The researchers identified three nationally representative comparison groups: those without self-reported mental or physical limitations; those with a limitation but who did not need daily living assistance; and those who needed assistance with daily living. The researchers evaluated access to medical care through self-reported survey answers to questions about attainment and delay of primary care services and of prescription medications. The number of emergency department visits was also self-reported.

The investigators made recommendations for provider and policymaker actions to offset some of the need for emergency care by individuals with disabilities. Prevention and chronic-condition management programs tailored for the functional limitations and service needs of people with disabilities may help avoid a crisis situation that would call for an urgent-care visit, the report noted. The authors also endorsed wider adoption of coordinated-care systems for the disabled that provide case management, integration of psychosocial care, and 24/7 access to medical assistance, among other services.

When a patient is admitted to the emergency department, sharing detailed medical information between emergency room and primary care staff could prevent repeat visits, the researchers says. Such coordination is particularly important for disabled patients, as they may have limitations that interfere with medical self-advocacy and complex conditions that demand care from various providers.

“When a person has an emergency department visit, their primary care providers often don’t know or don't get the results of that visit, and vice versa. The emergency department often doesn't know about the complex medical history people bring with them,” said co-author Elizabeth Rasch, PhD. “That's where things tend to break down.”

Source: NIH; January 2, 2013.

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