Characteristics of psychiatric emergency department use among privately insured adolescents with autism spectrum disorder

Kalb, Luther G.; Stuart, Elizabeth A.; Vasa, Roma A.

doi:10.1177/1362361317749951

Cited by 24 publications

(25 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Individuals with autism spectrum disorder (ASD) have significantly higher ED utilization than individuals without ASD across the lifespan [Deavenport‐Saman, Lu, Smith, & Yin, ; Vohra, Madhavan, & Sambamoorthi, ; Weiss et al, ; Liu, Pearl, Kong, Leslie, & Murray, ; Cohen‐Silver, Muskat, & Ratnapalan, ]. Preadolescents and adolescents with ASD may be at particularly increased risk for frequent ED utilization [Benevides, Carretta, & Graves, ; Schlenz, Carpenter, Bradley, Charles, & Boan, ] and have an increased probability of ED recidivism, relative to peers [Kalb, Stuart, & Vasa, ]. One possible explanation for this phenomenon is that adolescents with ASD, who often have co‐occurring psychiatric and medical conditions [Cummings et al, ], have poor continuity of care [Rast, Shattuck, Roux, Anderson, & Kuo, ] as a result of challenges navigating the healthcare system [Vogan, Lake, Tint, Weiss, & Lunsky, ].…”

Section: Introductionmentioning

confidence: 99%

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

et al. 2019

View full text Add to dashboard Cite

Adolescents with autism spectrum disorder (ASD) and/or intellectual disability (ID) may utilize the emergency department (ED) more frequently than individuals in the general population. This study compared ED utilization and charges during adolescence among four groups of individuals: ASD‐only, ASD + ID, ID‐only, and a population comparison (PC) group. ED visits occurring during age 12–17 years were examined to identify non, low, and high utilizers. Logistic regression was used to compare groups on the odds of having at least one ED visit during adolescence. Generalized linear models were used to compare groups on number of ED visits and total charges, stratified by low and high ED utilization. Descriptive examination of presenting diagnoses was performed. Individuals with ID, with or without co‐occurring ASD, were significantly more likely to have at least one ED visit during adolescence. Among high ED utilizers, the ID‐only group had the most frequent ED visits but had significantly lower charges than the ASD‐only group. Individuals with ASD‐only and ASD + ID differed from the ID‐only and PC groups in presenting diagnoses. No differences between groups in number of ED visits or charges were observed among low utilizers. ID, with or without ASD, increased the odds of visiting the ED during adolescence. Adolescents with ID‐only had the most frequent ED visits, but individuals with ASD‐only had the highest ED charges and tended to be seen for psychiatric concerns. Further research is warranted to better characterize and meet the healthcare needs of individuals with ASD and/or ID during adolescence. Autism Res 2019, 12: 1129–1138. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Frequent emergency department (ED) visits strain medical resources and are costlier than primary and urgent care. Our findings show that adolescents with intellectual disability (ID) may use the ED frequently for nonurgent conditions. Adolescents with autism spectrum disorder, without ID, use the ED less frequently but incur higher charges. Further research is needed to understand how to meet the unique needs of these populations in primary care to prevent overuse of the ED.

show abstract

Section: Introductionmentioning

confidence: 99%

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Recent studies have reported that children and adolescents with ASD are more likely to visit an emergency department (ED) and exhibit higher rates of ED encounters and repeat ED visits compared to their counterparts without ASD (Deavenport-Saman et al, 2016;Kalb et al, 2019;Liu et al, 2017;Lytle et al, 2018;Vohra et al, 2016). EDs are an essential component of the US healthcare system, since beyond urgent care, they provide afterhours care and are legally mandated to treat all patients who seek care in these settings (Zibulewsky, 2001).…”

mentioning

confidence: 99%

“…While the existing literature has provided valuable information about the use of EDs by children and adolescents with ASD, most prior work does not provide evidence past 2013 (Benevides et al, 2020;Casey et al, 2015;Croen et al, 2006;Deavenport-Saman et al, 2016;Iannuzzi et al, 2015;Kalb et al, 2012Kalb et al, , 2019Liu et al, 2017Liu et al, , 2019Vohra et al, 2016). In addition, prior work has not fully explored frequent ED use in this population, with Vohra and colleagues pointing at the need to examine frequent ED use in individuals with ASD (Vohra et al, 2016).…”

mentioning

confidence: 99%

“…Thus, there is reason to believe that children and adolescents with ASD might be more likely to exhibit frequent ED use compared to those without ASD. However, there is lack of evidence on the association between ASD and frequent ED use, since most studies focus on analyzing ED visit rates within a particular payer or insurance type (Benevides et al, 2020;Croen et al, 2006;Kalb et al, 2019;Liu et al, 2017Liu et al, , 2019.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Examining frequent emergency department use among children and adolescents with autism spectrum disorder

Beverly

Giannouchos

Callaghan

2021

Autism

View full text Add to dashboard Cite

We analyze the 2011–2016 Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases for all emergency department visits by children and adolescents in New York to estimate the association between autism spectrum disorder and frequent emergency department utilization. Our study included 5.9 million individuals with 9.1 million emergency department visits. Of those, 31,682 had autism spectrum disorder (0.5%) accounting for 66,053 (0.7%) emergency department visits. Individuals with autism spectrum disorder had on average 0.6 more emergency department visits per year, were more likely to exhibit frequent emergency department use (⩾4, ⩾6, ⩾8, and ⩾10 emergency department visits/year), and had larger shares of comorbidities and diagnoses related to attention-deficit/hyperactivity disorder, intellectual disability, and epilepsy. These findings highlight the need for patient and family-centered care interventions and emergency department staff education initiatives. Lay abstract This study used data for 5.9 million individuals with 9.1 million emergency department visits from all hospitals in the state of New York to explore frequent emergency department use between children and adolescents with autism spectrum disorders and those without autism spectrum disorders. We found that children and adolescents with autism spectrum disorders had larger shares of comorbidities and diagnoses related to attention-deficit/hyperactivity disorder, intellectual disability, and epilepsy. Children and adolescents with autism spectrum disorders were also more likely to utilize emergency departments and to exhibit frequent use. These results emphasize the need for using family-centered care to improve the care experiences of children and youth with autism spectrum disorders and their families. In addition, the education of emergency department staff of processes and practices as it relates to delivery of care and the care experience.

show abstract

“…Inadequate primary care may reduce autistic adults’ access to preventive services (Benevides et al, 2017) and leave common physical and mental health conditions, such as hypertension and depression (Croen et al, 2015), untreated. If not addressed, these conditions can have serious health consequences including cardiovascular disease (Croen et al, 2015), over-reliance on emergency department services (Hand et al, 2019a; Kalb et al, 2019), and premature death (Hirvikoski et al, 2016). As such, in the United States, there is a nationally recognized demand for improved healthcare service delivery models that promote continuity of care for autistic individuals across the lifespan (Interagency Autism Coordinating Committee, 2017).…”

Section: Introductionmentioning

confidence: 99%

Specialized primary care medical home: A positive impact on continuity of care among autistic adults

Hand

Coury

White

et al. 2020

Autism

View full text Add to dashboard Cite

While the medical home has proven effective at improving continuity of care among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. We conducted a retrospective cohort study to compare the continuity of care of autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the Center for Autism Services and Transition (CAST), to propensity score matched national samples of autistic adults with private insurance or Medicare. The unadjusted median Bice–Boxerman continuity of care index was 0.6 (interquartile range = 0.4–1.0) for CAST patients, 0.5 (interquartile range = 0.3–1.0) for Medicare beneficiaries, and 0.6 (interquartile range = 0.4–1.0) for privately insured autistic adults. In multivariable models controlling for demographic characteristics, on average, CAST patients had continuity of care indices that were 10% higher than national samples of autistic adult Medicare beneficiaries (p < 0.0001). Continuity of care among CAST patients did not significantly differ from that of the national sample of privately insured autistic adults (p = 0.08). Our findings suggest that medical homes, like CAST, may be a promising solution to improve healthcare delivery for the growing population of autistic adults. Lay abstract There is a nationally recognized need for innovative healthcare delivery models to improve care continuity for autistic adults as they age out of pediatric and into adult healthcare systems. One possible model of care delivery is called the “medical home”. The medical home is not a residential home, but a system where a patient’s healthcare is coordinated through a primary care physician to ensure necessary care is received when and where the patient needs it. We compared the continuity of care among autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the CAST, to matched national samples of autistic adults with private insurance or Medicare. Continuity of primary care among CAST patients was significantly better than that of matched national samples of autistic adult Medicare beneficiaries and similar to that of privately insured autistic adults. Our findings suggest that medical homes, like CAST, are a promising solution to improve healthcare delivery for the growing population of autistic adults.

show abstract

Characteristics of psychiatric emergency department use among privately insured adolescents with autism spectrum disorder

Cited by 24 publications

References 33 publications

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group

Examining frequent emergency department use among children and adolescents with autism spectrum disorder

Specialized primary care medical home: A positive impact on continuity of care among autistic adults

Contact Info

Product

Resources

About