Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Division of Psychiatry, University College London, London, United Kingdom.
PLoS Med. 2023 Mar 20;20(3):e1004117. doi: 10.1371/journal.pmed.1004117. eCollection 2023 Mar.
Accurate recognition and recording of intellectual disability in those who are admitted to general hospitals is necessary for making reasonable adjustments, ensuring equitable access, and monitoring quality of care. In this study, we determined the rate of recording of intellectual disability in those with the condition who were admitted to hospital and factors associated with the condition being unrecorded.
Retrospective cohort study using 2 linked datasets of routinely collected clinical data in England. We identified adults with diagnosed intellectual disability in a large secondary mental healthcare database and used general hospital records to investigate recording of intellectual disability when people were admitted to general hospitals between 2006 and 2019. Trends over time and factors associated with intellectual disability being unrecorded were investigated. We obtained data on 2,477 adults with intellectual disability who were admitted to a general hospital in England at least once during the study period (total number of admissions = 27,314; median number of admissions = 5). People with intellectual disability were accurately recorded as having the condition during 2.9% (95% CI 2.7% to 3.1%) of their admissions. Broadening the criteria to include a nonspecific code of learning difficulty increased recording to 27.7% (95% CI 27.2% to 28.3%) of all admissions. In analyses adjusted for age, sex, ethnicity, and socioeconomic deprivation, having a mild intellectual disability and being married were associated with increased odds of the intellectual disability being unrecorded in hospital records. We had no measure of quality of hospital care received and could not relate this to the presence or absence of a record of intellectual disability in the patient record.
Recognition and recording of intellectual disability in adults admitted to English general hospitals needs to be improved. Staff awareness training, screening at the point of admission, and data sharing between health and social care services could improve care for people with intellectual disability.
准确识别和记录入住综合医院的智力障碍患者，对于做出合理调整、确保公平获得服务机会以及监测护理质量非常重要。本研究旨在确定患有智力障碍的患者在住院时记录该障碍的比例，并分析与未记录该障碍相关的因素。
这是一项在英格兰使用 2 个常规收集临床数据的链接数据集进行的回顾性队列研究。我们在一个大型二级精神卫生保健数据库中识别出患有确诊智力障碍的成年人，并使用综合医院记录调查 2006 年至 2019 年期间患者入住综合医院时记录智力障碍的情况。我们分析了随时间的变化趋势和与智力障碍未被记录相关的因素。我们获得了在研究期间至少一次入住英格兰综合医院的 2477 名成年智力障碍患者的数据（总入院人数=27314；中位数入院人数=5）。在患者的 2.9%（95%CI 2.7%至 3.1%）的入院记录中准确记录了他们患有该疾病。将标准放宽到包括非特定的学习困难代码，可将所有入院记录中记录该疾病的比例提高到 27.7%（95%CI 27.2%至 28.3%）。在调整了年龄、性别、族裔和社会经济贫困程度后，轻度智力障碍和已婚与智力障碍在医院记录中未被记录的可能性增加有关。我们没有衡量医院护理质量的指标，也无法将其与患者记录中是否存在智力障碍记录相关联。
英国综合医院收治的成年患者的智力障碍识别和记录工作有待改进。工作人员的意识培训、入院时的筛查以及卫生和社会保健服务之间的数据共享，可以改善智力障碍患者的护理。
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