Date of Award

1-1-2014

Language

English

Document Type

Dissertation

Degree Name

Doctor of Public Health (DrPH)

College/School/Department

School of Public Health

Content Description

1 online resource (x, 145 pages) : illustrations (some color)

Dissertation/Thesis Chair

Benjamin Shaw

Committee Members

Brigida Hernandez, Barry Sherman

Keywords

Developmental Disabilities, Emergency Room, Hospitalization, Intellectual and Developmental Disabilities, Managed Care, Medicaid, Hospitals, Emergency medical services, Developmentally disabled

Subject Categories

Public Health | Public Policy

Abstract

Background. Avoidable emergency room (ER) visits and hospital admissions among people with intellectual and developmental disabilities (IDD) contribute significantly to rising Medicaid costs. The Affordable Care Act (ACA) and New York State (NYS) Medicaid Redesign Team have identified a critical need to reduce ER and hospital utilization in an effort to contain healthcare costs and improve quality of care. Study Objective. This study identifies independent predictors of medical and behavioral/psychiatric ER and hospital utilization for a cohort of individuals with IDD (n=597) residing in supported living arrangements in New York City, the most Medicaid-dense region of NYS. Methods. A retrospective survey of 597 medical charts was conducted. Bivariate analyses identified associations between independent variables and ER and hospital utilization. Guided by Andersen's Behavioral Model of Health Services Utilization, multivariate logistic regression identified predisposing and enabling predictors of utilization. Results. Predisposing and enabling factors independently predicted ER utilization, which was high within this cohort when compared to the general population, while predisposing factors had a direct effect on hospitalization rates, which were lower than for the general population. Significant predisposing risk factors for medical emergencies included age, number of chronic health conditions, a diagnosis of cerebral palsy or neurological disorder, mental illness and polypharmacy. Residing in supported living and in the Bronx served as enabling predictors of medical ER visits, suggesting that contextual characteristics of these settings uniquely contributed to increased utilization. Age and number of chronic conditions increased risk of medical hospitalization, while residing in an institutional setting was a weak protective factor. Mental illness was the sole predictor of behavioral/psychiatric ER visits. Further research is needed to determine predictors of behavioral/psychiatric hospitalization. Conclusion. The current study demonstrates overlap in predisposing utilization predictors between people with IDD and those in the general public. However, a number of risk factors were unique to the IDD population. High-risk characteristics of people with IDD should be targeted through public health intervention to reduce ER and hospital utilization rates, which is integral to NYS' cost containment efforts and the transition to managed care.

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