Ambulatory Care Sensitive Conditions Among All-Payer Claimants With Intellectual and Developmental Disabilities

Area of Science:

• Health Services Research
• Public Health
• Disability Studies

Background:

• Ambulatory care sensitive conditions (ACSC) are associated with preventable hospitalizations.
• Individuals with intellectual and developmental disabilities (IDD) may face unique healthcare challenges.
• Understanding healthcare utilization disparities is essential for targeted interventions.

Purpose of the Study:

• To compare inpatient hospitalizations for ACSC between beneficiaries with and without IDD.
• To analyze differences in ACSC prevalence and healthcare utilization based on insurance type (Medicaid vs. commercial).
• To highlight the importance of all-payer claims data for studying IDD populations.

Main Methods:

• Analysis of Medicaid and commercial claims data from New Hampshire (2010-2014).
• Definition of IDD using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes and Centers for Medicare and Medicaid Services algorithms.
• Identification of inpatient encounters using the Healthcare Effectiveness Data and Information Set (HEDIS).

Main Results:

• Beneficiaries with IDD had significantly more hospitalizations for ACSC compared to those without IDD, across both insurance groups.
• Distinct patterns in ACSC prevalence, comorbidities, and hospital admission rates were observed between Medicaid and commercially insured groups.
• Adjusted analyses confirmed higher ACSC hospitalization rates for individuals with IDD.

Conclusions:

• Individuals with IDD are at a higher risk for preventable hospitalizations due to ambulatory care sensitive conditions.
• Differences in healthcare utilization and prevalence underscore the need for tailored health strategies for IDD populations.
• Utilizing all-payer claims data provides a comprehensive view of healthcare needs and utilization for beneficiaries with IDD.