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Study: Disabled adults account for 39% of ED visits
Monday January 7, 2013

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Working-age adults with disabilities comprise a disproportionately high amount of annual emergency department visitors, according to a study.

Because ED care may not be the best way to address non-urgent concerns and is higher in cost, finding a way to decrease these visits is of interest to many stakeholders, said researchers with the National Institutes of Health.

The researchers analyzed pooled data from the Medical Expenditure Panel Survey, and found that access to regular medical care, health profile complexity and disability status contributed to disabled patientsí use of the ED. To address the disparity, the authors recommend enhanced communication between ED and primary care physicians and tailored prevention and primary care programs.

"We want to understand what takes people to the emergency department to learn if their care could be better managed in other ways," Elizabeth Rasch, PhD, chief of the Epidemiology and Biostatistics Section in the NIH Clinical Centerís Rehabilitation Medicine Department, said in a news release. "While many of those visits may be necessary, it is likely that some could be avoided through better information sharing among all of the healthcare providers who see a particular individual."

The study found that while representing 17% of the working age U.S. population, adults with disabilities accounted for 39.2% of total ED visits. Those with a severely limiting disability visited an urgent care department more often than their peers and were more likely to visit the ED more than four times per year.

Emergency visits also were associated with poor access to primary medical care, which was more prevalent among adults with disabilities.

Rasch and her coauthors with the NIH Clinical Center and Brandeis University in Waltham, Mass., identified three nationally representative comparison groups: those without any self-reported mental or physical limitations, those with a limitation but who did not need daily living assistance and those who did need 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 prescription medications. The number of ED visits also was self-reported.

The authors 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 researchers noted. The authors also endorsed wider adoption of coordinated care systems for the disabled that provide case management, integration of psychosocial care and round-the-clock access to medical assistance, among other services.

When a patient is admitted to the ED, sharing detailed medical information between ED and primary care staff could prevent repeat visits. Such coordination particularly is important for disabled patients because they might 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 donít know or donít get the results of that visit, and vice versa," Rasch said. "The emergency department often doesnít know about the complex medical history people bring with them. Thatís where things tend to break down."

The study appeared on the website of the journal Health Services Research. The study abstract is available at onlinelibrary.wiley.com/doi/10.1111/1475-6773.12025/abstract. A video with commentary by Rasch is available at youtube.com/watch?v=ydb10shy06Y.


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Monday January 7, 2013
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