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Potentially Preventable Hospitalizations Among Adults With Pediatric-Onset Disabilities
Elham Mahmoudi1, Paul Lin2, Anam Khan3
1Department of Family Medicine, Michigan Medicine, University of Michigan; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
Insights
Adults with cerebral palsy (CP) and spina bifida (SB) face significantly higher risks for potentially preventable hospitalizations (PPHs). Enhanced preventive care access, particularly for respiratory and urinary issues, can mitigate these risks.
Area of Science:
- Public Health
- Disability Studies
- Healthcare Management
Background:
- Adults with pediatric-onset disabilities, such as cerebral palsy (CP) and spina bifida (SB), often experience complex health needs.
- Potentially preventable hospitalizations (PPHs) represent a significant burden on healthcare systems and can indicate gaps in primary and preventive care.
Purpose of the Study:
- To investigate the risk of PPHs in adults with CP or SB compared to the general population.
- To identify specific types of PPHs that are more prevalent in adults with CP/SB.
- To explore the impact of preventive care, such as annual wellness visits, on PPH risk in this population.
Main Methods:
- Analysis of national private administrative claims data (OptumInsight) from January 1, 2007, to December 31, 2017.
- Identification of adults with CP/SB (n=10,617) and propensity-matched controls without these conditions (n=10,617).
- Use of generalized estimating equation models to assess PPH risk, adjusting for demographic, socioeconomic, and health indicator variables.
Main Results:
- Adults with CP/SB exhibited a significantly higher risk for any PPH (OR, 4.10).
- Elevated risks were observed for PPHs related to chronic obstructive pulmonary disease/asthma (OR, 1.85), pneumonia (OR, 3.01), and urinary tract infection (OR, 6.48).
- Annual wellness visits were associated with lower PPH risk overall (OR, 0.52) and specifically for adults with CP/SB (OR, 0.75).
Conclusions:
- Adults with CP/SB face a substantially increased risk of PPHs.
- Targeted interventions focusing on respiratory and urinary health, alongside improved access to preventive services, are crucial for reducing PPHs in this population.
- Regular engagement in preventive care, such as annual wellness visits, can effectively lower the incidence of PPHs among individuals with CP/SB.
Objective:
To examine the risk of any and specific potentially preventable hospitalizations (PPHs) for adults with cerebral palsy (CP) or spina bifida (SB). We hypothesize that PPH risk is greater among adults with CP/SB compared with the general population.
Patients And Methods:
Using January 1, 2007, to December 31, 2017, national private administrative claims data (OptumInsight) in the United States, we identified adults with CP/SB (n=10,617). Adults without CP/SB were included as controls (n=1,443,716). To ensure a similar proportion in basic demographics, we propensity-matched our controls with cases in age and sex (n=10,617). Generalized estimating equation models were applied to examine the risk of CP/SB on PPHs. All models were adjusted for age, sex, race/ethnicity, health indicators, US Census Division data, and socioeconomic variables. Adjusted odds ratios were compared within a 4-year follow-up.
Results:
Adults with CP/SB had higher risk for any PPH (odds ratio [OR], 4.10; 95% CI, 2.31 to 7.31), and PPHs due to chronic obstructive pulmonary disease/asthma (OR, 1.85; CI, 1.23 to 2.76), pneumonia (OR, 3.01; 95% CI, 2.06 to 4.39), and urinary tract infection (OR, 6.48; 95% CI, 3.91 to 10.75). Cases and controls who had an annual wellness visit had lower PPH risk (OR, 0.52; 95% CI, 0.41 to 0.67); similarly, adults with CP/SB who had an annual wellness visit compared with adults with CP/SB who did not had lower odds of PPH (OR, 0.75; 95% CI, 0.60 to 0.94).
Conclusion:
Adults with pediatric-onset disabilities are at a greater risk for PPHs. Providing better access to preventive care and health-promoting services, especially for respiratory and urinary outcomes, may reduce PPH risk among this patient population.
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