Use of Emergency Departments among Working Age Adults with Disabilities: A Problem of Access and Service Needs

Rasch, Elizabeth K.; Gulley, Stephen P.; Chan, Leighton

doi:10.1111/1475-6773.12025

Cited by 29 publications

(24 citation statements)

References 31 publications

(48 reference statements)

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“…There are no studies from the dental literature to which we can directly compare our findings. However, two studies suggest that general ED use is higher in adults with IDDs (Lunsky et al, 2011; Rasch, Gulley, & Chan, 2013) and two studies have focused on ED use in adults with IDDs (Lunsky & Elserafi, 2011; Venkat, Pastin, Hedge, Shea, Cook, & Culig, 2011). There are three main explanations for our finding.…”

Section: Discussionmentioning

confidence: 99%

U.S. Emergency Department Admissions for Nontraumatic Dental Conditions for Individuals With Intellectual and Developmental Disabilities

Donald¹,

Masterson²,

Wong³

2014

Intellectual and Developmental Disabilities

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We hypothesized that individuals with intellectual and developmental disabilities (IDDs) are more likely to have an emergency department (ED) admission for non-traumatic dental conditions (NTDCs). We analyzed 2009 U.S. National Emergency Department Sample data and ran logistic regression models for children ages 3-17 years and adults ages 18+ years. The prevalence of NTDC-related ED admissions was 0.8% for children and 2.0% for adults. Children with IDDs were at increased odds of NTDC-related ED admission, but this difference was not statistically significant (pOR=1.06; 95% CI=0.91,1.23). Adults with IDDs had significantly lower odds of an ED admission for NTDCs (pOR=0.49;95% CI=0.44,0.54). Children with IDDs are not at increased odds of NTDC-related ED admissions whereas adults with IDDs are at significantly reduced odds.

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Section: Discussionmentioning

confidence: 99%

U.S. Emergency Department Admissions for Nontraumatic Dental Conditions for Individuals With Intellectual and Developmental Disabilities

Donald¹,

Masterson²,

Wong³

2014

Intellectual and Developmental Disabilities

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“…Interventions that increase access to PCPs for older adults with chronic illness or disabilities have estimated decreases in ED visits rates of 18% to 40%. [3][4][5]24 The findings of the current study do not directly contradict these findings, which evaluate intensive primary care efforts in chronically ill populations, although they indicate that the reductions observed in these trials are smaller than the large variation in ED use by older adults present across a population and suggest that, in North Carolina, primary care availability as currently provided to older adults has, at most, a small effect on ED use.…”

Section: Discussionmentioning

confidence: 64%

Primary Care Availability and Emergency Department Use by Older Adults: A Population‐Based Analysis

Hunold

Richmond

Waller

et al. 2014

J American Geriatrics Society

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OBJECTIVES To assess the relationship between the number of primary care providers (PCPs) in an area and emergency department (ED) visits by older adults. DESIGN Population-based cross-sectional observational study. SETTING Nonfederal EDs in North Carolina in 2010. PARTICIPANTS All older adults (n = 640,086) presenting to a nonfederal ED in North Carolina in 2010. MEASUREMENTS The primary outcome was the number of ED visits by older adults in each ZIP code per 100 adults aged 65 and older living in that ZIP code. A secondary outcome was the number of ED visits not resulting in hospital admission per 100 older adults. The primary predictor variable was the number of PCPs per 100 older residents for each ZIP code. Covariates included those representing healthcare need (Medicare hospitalizations, nursing home beds), predisposing factors for healthcare use (race, education, population density of older adults), and enabling factors (distance to the nearest ED). RESULTS In a multivariable regression model corrected for spatial clustering, ZIP code characteristics associated with ED visits included more hospitalizations by Medicare beneficiaries, more nursing home beds, and closer proximity to an ED. Number of PCPs per 100 older adult residents in each ZIP code was not associated with ED use, and the 95% confidence limit indicates at most a small effect of PCP availability on ED use. CONCLUSION These findings suggest that primary care availability has at most a limited effect on ED use by older adults in North Carolina.

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“…It is used to track health care services among subsets of the population, including people with disabilities (26–29). Multiple studies have demonstrated the use of the MEPS for analyzing health disparities among and between disability groups (16,18,24,26–30).…”

Section: Methodsmentioning

confidence: 99%

Disability, Health, and Multiple Chronic Conditions Among People Eligible for Both Medicare and Medicaid, 2005–2010

Fox¹,

Reichard²

2013

Prev. Chronic Dis.

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IntroductionPeople who are eligible for both Medicare and Medicaid (dual eligibles) and who have disabilities and multiple chronic conditions (MCC) present challenges for treatment, preventive services, and cost-effective access to care within the US health system. We sought to better understand dual eligibles and their association with MCC, accounting for sociodemographic factors inclusive of functional disability category.MethodsMedical Expenditure Panel Survey (MEPS) data for 2005 through 2010 were stratified by ages 18 to 64 and 65 or older to account for unique subsets of dual eligibles. Prevalence of MCC was calculated for those with physical disabilities, physical plus cognitive disabilities, and all others, accounting for sociodemographic and health-related factors. Adjusted odds for having MCC were calculated by using logistic regression.ResultsOf dual eligibles aged 18 to 64, 53% had MCC compared with 73.5% of those aged 65 or older. Sixty-five percent of all dual eligibles had 2 or more chronic conditions, and among dual eligibles aged 65 or older with physical disabilities and cognitive limitations, 35% had 4 or more, with hypertension and arthritis the most common conditions. Dual eligibles aged 18 to 64 who had a usual source of medical care had a 127% increased likelihood of having MCC compared with those who did not have a usual source of care.ConclusionAttention to disability can be a component to helping further understand the relationship between health and chronic conditions for dual eligible populations and other segments of our society with complex health and medical needs.

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Use of Emergency Departments among Working Age Adults with Disabilities: A Problem of Access and Service Needs

Cited by 29 publications

References 31 publications

U.S. Emergency Department Admissions for Nontraumatic Dental Conditions for Individuals With Intellectual and Developmental Disabilities

U.S. Emergency Department Admissions for Nontraumatic Dental Conditions for Individuals With Intellectual and Developmental Disabilities

Primary Care Availability and Emergency Department Use by Older Adults: A Population‐Based Analysis

Disability, Health, and Multiple Chronic Conditions Among People Eligible for Both Medicare and Medicaid, 2005–2010

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