Quality of Medical Care for Adults With Intellectual/Developmental Disabilities

QUALITY OF MEDICAL CARE FOR ADULTS WITH INTELLECTUAL/DEVELOPMENTAL DISABILITIES By Priya Chandan, M.D., M.P.H. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2020. Director: Director: Gloria J. Bazzoli, Ph.D. Bon Secours Professor, Department of Health Administration People with intellectual/developmental disabilities (IDD) are difficult to identify in administrative data, limiting the ability to study the quality of health care provided to this population. This study utilized clinical diagnoses to define a sample of hospitalized patients with IDD in the largest publicly available all-payer inpatient care database—the Nationwide Inpatient Sample. Study aims were to define and describe the inpatient medical care of adults with IDD in the United States, to examine the quality of primary care received by IDD patients through the study of preventable hospitalizations, and to assess the quality of inpatient medical care by examining adverse events that could arise in hospitalized IDD patients. Econometric methodologies, including propensity score matching and multivariate analyses, were used to test two hypotheses developed from organizational theory and health services research frameworks. Descriptive results highlighted epilepsy and other neurological disorders, hypothyroidism, depression, obesity, and psychoses as comorbidities experienced more commonly by hospitalized patients with IDD. Specifically, psychoses were 6.5 times more common in hospitalized patients with IDD, suggesting the importance of future research and policy efforts related to appropriate diagnosis and treatment of psychotic disorders in IDD patients, psychotropic polypharmacy, and potential side effects of aspiration and gastroesophageal reflux disease. Though study hypotheses were not supported, findings suggested that specific comorbidities confer greater odds of preventable hospitalization, which challenges assumptions regarding inherent medical complexity necessitating admission due to IDD diagnosis. To decrease preventable hospitalizations, findings suggest focusing on quality management of obesity and hypothyroidism in adults with IDD