Time trends in emergency department use among adults with intellectual and developmental disabilities |
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| Affiliation: | 1. Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA;2. Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA;3. Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, KS, USA;4. Michigan Department of Health and Human Services, Lansing, MI, USA;5. Institute on Disability, University of New Hampshire, Durham, NH, USA;6. Public Policy Center, University of Iowa, Iowa City, IA, USA;7. New York State Department of Health, Albany, NY, USA;8. Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Shrewsbury, MA, USA;9. Commonwealth Medicine, University of Massachusetts Medical School, Shrewsbury, MA, USA;10. Montana Department of Public Health & Human Services, Helena, MT, USA;11. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, USA;12. School of Public Health & Health Policy, City University of New York, New York, NY, USA;1. Oregon Health & Science University, Institute on Development and Disability, 707 SW Gaines Street, Portland, OR, 97239, USA;2. OHSU-PSU School of Public Health, 1810 SW 5th Ave, Portland, OR 97201, USA;3. Office of Equity and Inclusion, Oregon Health Authority, 421 SW Oak Street, Suite 750, Portland, OR 97204, USA;1. Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada;2. Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, Canada;1. Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA;2. Department of Epidemiology, University of Florida, Gainesville, FL, USA |
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| Abstract: | BackgroundEmergency 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.ObjectiveTo 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.MethodsWe 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.ResultsStates 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.ConclusionsMedicaid 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. |
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| Keywords: | Intellectual disability Developmental disabilities Emergency departments Medicaid Health policy |
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