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NIH Assesses High Rates of ED Visits by Adults With Disabilities

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Working-age adults with disabilities account for a disproportionately high amount of annual emergency department visitors, reports a comparison study from National Institutes of Health researchers.

As ED care may not be the best to address non-urgent concerns and is higher in cost, finding a way to decrease these visits is of interest to many stakeholders.

One of the first detailed looks at this population's heightened use of urgent care, the NIH study published online in Health Services Research on Dec. 26, analyzed pooled data from the Medical Expenditure Panel Survey.

Researchers found access to regular medical care, health profile complexity and disability status contributed to people with disabilities' use of the ED. To address this 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," said Elizabeth Rasch, PhD, chief of the Epidemiology and Biostatistics Section in the NIH Clinical Center's Rehabilitation Medicine Department.

"While many of those visits may be necessary," she said, "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 despite representing 17 percent of the working age U.S. population, adults with disabilities accounted for 39.2 percent of total emergency room visits.

Those with a severely limiting disability visited an urgent care department more often than their peers and were more likely to visit the department more than four times per year.

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

Rasch and her coauthors 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.

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 emergency department visits was also self-reported.

The authors, from the NIH Clinical Center and Brandeis University, Waltham, MA, 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 report noted. The authors also endorsed wider adoption of coordinated care systems for the disabled that provide case management, integration of psychosocial care and 24/7 access to medical assistance, among other services.

When a patient is admitted to the emergency department, sharing detailed medical information between emergency room and primary care staff could prevent repeat visits. Such coordination is particularly important for disabled patients as they may 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 don't know or don't get the results of that visit, and vice versa. The emergency department often doesn't know about the complex medical history people bring with them," Rasch said. "That's where things tend to break down."

For more on these research findings see the video below.


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