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Emergency department use among young adult Medicare beneficiaries with autism and intellectual disabilities

Abstract

Background

Individuals on the autism spectrum are at greater risk for a variety of co-occurring psychiatric and medical conditions, which could result in greater emergency department (ED) use. We aimed to identify rates of ED utilization among transition-age young adults with autism and examine predictors of utilization in a U.S. national data source.

Methods

We conducted a retrospective analysis of Centers for Medicare and Medicaid 2010 Limited Data Set claims from Inpatient and Outpatient files. Medicare beneficiaries aged 18–25 years from three groups were included: autism spectrum disorder (ASD) and no intellectual disability (ID), ASD and ID, and ID-only. Primary outcomes were annual ED visit counts and dichotomous presence of ED visit in claim year.

Results

Between 43–54% of adults with ASD had an ED visit in the past claim year. Significant predictors of greater ED utilization among adults with ASD included: intellectual disability (IRR=1.19, 95%CI:1.09–1.30), psychiatric utilization in the claim year (IRR=1.42, 95%CI:1.28–1.57), and greater comorbidities as assessed with ACG® risk score (IRR=1.18, 95%CI:1.15–1.20). Minority status was associated with less ED utilization among adults with ASD (IRR=0.86, 95%CI:0.78–0.94). Adults with ASD had significantly fewer annual ED visits than adults with ID-only after controlling for other variables.

Conclusions

Prevention efforts to reduce ED utilization, especially for those with ID and ASD with co-occurring psychiatric conditions, is warranted. Primary care providers and case managers should develop care plans to reduce the likelihood for emergency psychiatric utilization and ensure alternative care pathways. ED clinicians may require additional training to address the needs of this population when they present to the ED in crisis.