Use of emergency medical services by adults with developmental disabilities receiving integrated or usual care

Adults with developmental disabilities (DD) frequently utilize the emergency department (ED) and are hospitalized for psychiatric emergencies. Community healthcare models like integrated care where primary care and mental health services are co-located may better meet the needs of adults with DD and reduce use of emergency services.

To determine odds of all-cause, psychiatric, and non-psychiatric ED use and hospitalization among adults with DD receiving integrated care relative to usual care.

We analyzed inpatient and outpatient encounters in the electronic health record from 2022 to 2023 from an integrated and usual care clinic. Adults with DD were identified using ICD-10 codes, and HCUP Clinical Classification Software was used to identify psychiatric hospitalizations and psychiatric ED visits. Logistic regression was used to determine odds of study outcomes among patients receiving integrated versus usual care, controlling for demographic characteristics.

N = 6706 adults with DD were included. Relative to usual care, individuals receiving integrated care had 50% lower odds of all-cause ED use (OR = 0.50, 95% CI = 0.44 - 0.57), and 38% lower odds of all-cause hospitalization (OR = 0.62, 95% CI = 0.52 - 0.74). Odds of psychiatric ED use and hospitalization were 72% (OR = 0.28, 95% CI = 0.17 - 0.44) and 65% (OR = 0.35, 95% CI = 0.19 - 0.65) lower for adults with DD receiving integrated care.

Integrated care was associated with lower odds of ED use and hospitalization for adults with DD and may be a promising model of service delivery. Future longitudinal studies are needed to better understand the effect of integrated care on use of emergency services for this population.