Center for Epidemiological Research for Individuals With Intellectual and Developmental Disabilities (CERIIDD), 1152 Goodale Blvd, Columbus, OH, 43212, USA.
Ohio's Coordinating Center for Excellence in Mental Illness/Intellectual Disability, Department of Psychiatry, Wright State University, 627 Edwin C. Moses Blvd, Dayton, OH, 45417, USA.
Community Ment Health J. 2021 Apr;57(3):482-489. doi: 10.1007/s10597-020-00669-6. Epub 2020 Jun 26.
The purpose of the study was to determine the acute and long term services and supports (LTSS) utilization, cost of health care and disparities in access of care for individuals with Intellectual and Developmental Disabilities (IDD). Individuals with IDD on a waiver (receiving Medicaid-funded LTSS in community settings) compared to non-IDD individuals on a waiver control group were compared using Ohio Medicaid claims data from calendar year 2013. Results found the IDD Waiver population had lower utilization rates for emergency department visits, hospital admissions, and hospital readmissions within 30 days compared to the Non-IDD Waiver population and lower PMPM expenditures across all medical service categories except pharmacy. However, the IDD Waiver population possessed greater PMPM costs for LTSS and therefore greater overall costs of care. Furthermore, 94% of IDD Waiver individuals had an episode of care for neurological conditions, with the second most frequent episode of care being for mental health services. The two most frequent episodes of care for individuals in the Non-IDD Waiver group were for conditions related to treatment (medical/surgical) and musculoskeletal conditions. The goal of this research was to investigate the health care needs of individuals with IDD that may vary from other long term care populations. The differences in health care needs for individuals with IDD require health systems and care management that is tailored to the sub-population, with an emphasis on treatment for neurological and mental health conditions. The typical focus of care management efforts on reducing unnecessary utilization of hospital services may be less relevant to the IDD Waiver population. The results of this study will be used to make recommendations regarding the unique health care needs of individuals with IDD.
本研究旨在确定患有智力和发育障碍（ID）的个体的急性和长期服务和支持（LTSS）利用、医疗保健成本以及获得护理服务的差异。使用俄亥俄州医疗补助计划（Medicaid）索赔数据，将 2013 年日历年度接受豁免（在社区环境中获得 Medicaid 资助的 LTSS）的 ID 个体与豁免对照组中的非 ID 个体进行比较。结果发现，与非 ID 豁免人群相比，ID 豁免人群在急诊就诊、住院和 30 天内再次住院的利用率较低，除药房外，所有医疗服务类别中的 PMPM 支出也较低。然而，ID 豁免人群的 LTSS PMPM 成本更高，因此护理总成本更高。此外，94%的 ID 豁免个体都有神经疾病的治疗经历，其次最常见的治疗经历是心理健康服务。非 ID 豁免组个体最常见的两种治疗经历是与治疗（医疗/手术）和肌肉骨骼状况相关的疾病。本研究的目的是调查 ID 个体的医疗保健需求，这些需求可能与其他长期护理人群不同。ID 个体的医疗保健需求存在差异，这需要针对亚人群定制医疗系统和护理管理，重点是治疗神经和心理健康疾病。关注减少不必要的医院服务利用的护理管理工作的重点可能与 ID 豁免人群不太相关。本研究的结果将用于就 ID 个体的独特医疗保健需求提出建议。
