Effect of deinstitutionalisation for adults with intellectual disabilities on costs: a systematic review

Abstract

ObjectiveTo review systematically the evidence on the costs and cost-effectiveness of deinstitutionalisation for adults with intellectual disabilities.DesignSystematic review.PopulationAdults (aged 18 years and over) with intellectual disabilities.InterventionDeinstitutionalisation, that is, the move from institutional to community settings.Primary and secondary outcome measuresStudies were eligible if evaluating within any cost-consequence framework (eg, cost-effectiveness analysis, cost–utility analysis) or resource use typically considered to fall within the societal viewpoint (eg, cost to payers, service-users, families and informal care costs).SearchWe searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches and handsearching of the references of the eligible studies. We assessed study quality using the Critical Appraisals Skills Programme suite of tools, excluding those judged to be of poor methodological quality.ResultsTwo studies were included; both were cohort studies from the payer perspective of people leaving long-stay National Health Service hospitals in the UK between 1984 and 1992. One study found that deinstitutionalisation reduced costs, one study found an increase in costs.ConclusionA wide-ranging literature review found limited evidence on costs associated with deinstitutionalisation for people with intellectual disabilities. From two studies included in the review, the results were conflicting. Significant gaps in the evidence base were observable, particularly with respect to priority populations in contemporary policy: older people with intellectual disabilities and serious medical illness, and younger people with very complex needs and challenging behaviours.PROSPERO registration numberCRD42018077406

Effect of deinstitutionalisation on quality of life for adults with intellectual disabilities: a systematic review

“…Reasons for exclusion at quality assessment included no report of establishing consent of study participants, and insufficient and negligible data on participants and/or outcomes (see online supplementary appendix 3 for a list of studies excluded after quality assessment). Of the 15 studies remaining, two addressed economic outcomes only and are included in a separate paper 3. No eligible study looked at both economics and QoL.…”

“…In this paper we report the results for the QoL studies. The economics results, as well as further details on our search strategy, are available in a companion paper 3…”

Primary Care of Adults with Intellectual and Developmental Disabilities Clinic: Coordination of Care Challenges

“…Before the 1960s, most AIDDs lived in and received health care in institutional settings with onsite medical staff to treat patients. As such, clinicians in the community did not have the chance to interact with AIDDs throughout their careers, and as a result, medical schools did not feel obligated to train clinicians to care for AIDDs in community settings 4 …”

On the concept of deinstitutionalisation of care and the measures undertaken. Possibilities and limits.

“…In addition, the costs of operating care facilities depend significantly on therapeutic needs, which tend to be higher when dependency is accompanied by health problems requiring medical care and systematic rehabilitation. A review of the comparative literature on the operation of institutions, e.g., for people with intellectual disabilities (see: Mansell et al, 2007, Beadle-Brown & Kozma, 2007 and research in the UK (May et al, 2019) indicates that lower costs are not an obvious argument for moving towards deinstitutionalisation. Undertaking a process of so-called deinstitutionalisation often means, in practice, the need for investment: building a network of small centres in places where no such facilities previously existed.…”