Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England

Purpose Adults with intellectual disabilities (ID) experience poorer physical health and healthcare quality, but there is limited information on the scope for reducing emergency hospital admissions. We describe overall and preventable emergency admissions for adults with ID compared to the general population and assess differences in primary care management before admission for two common Ambulatory Care Sensitive conditions (ACSCs). Methods We used electronic records to study a matched cohort of 16,666 adults with ID and 113,562 age, sex and practice matched controls from 343 English family practices. Incident rate ratios (IRR) from conditional Poisson regression are analysed for all emergency and preventable (ACSC) emergency admissions. Primary care management of lower respiratory (LRTI) and urinary tract (UTI) infections, as exemplar ACSCs, prior to admission are compared in unmatched analysis between adults with and without ID. Results The overall rate for emergency admissions for adults with ID versus controls was 182 vs. 68 per 1000/year (IRR=2.82, 95%CI: 2.66–2.98). ACSCs accounted for 33.7% of emergency admissions compared to 17.3% in controls (IRR=5.62, 5.14-6.13); adjusting for comorbidity, smoking and deprivation did not explain the difference (IRR=3.60, 3.25–3.99). Despite adults with ID being at nearly five times higher risk for admissions from LRTI and UTI, they have similar primary care utilisation, investigation and management preceding admission, as the general population. Conclusion Adults with ID are at high risk of preventable emergency admissions. Identifying improvements for detection and management of ACSCs in primary care, including lower respiratory and urinary tract infections, could reduce hospitalisations