Sunday, January 13, 2013

Coordinated Emergency Care

Working age adults with disabilities account for a disproportionate high amount of annual emergency department visits, reports a recent study published online in Health Services Research. The authors of the study from the NIH Clinical Center and Brandeis University found that people with disabilities use the emergency room more than other patients.

When a patient is admitted to the emergency department, if detailed medical information was shared between the emergency room and primary care staff, then possibly repeat visits could be prevented. Coordination is particularly important for disabled patients as they may have limitations that interfere with medical self-advocacy and complex conditions that demand care from various providers.

According to Elizabeth Rasch, PhD, Chief of the Epidemiology and Biostatistics Section in the NIH Clinical Center’s Rehabilitation Medicine Department, “When a person visits the emergency department, their primary care providers often don’t know or don’t get the results of that visit, and vice versa. The emergency department often doesn’t know about the complex medical history people bring with them,”

The study found that despite representing 17 percent of the working age U.S. population, adults with disabilities account for 39.2 percent of the total emergency room visits. It was found that people with severely limiting disabilities visit an urgent care department more often than their peers and more likely to visit the department more than four times per years. Also, emergency visits were also associated with poor access to primary medical care which was more prevalent among adults with disabilities.

The authors identified three nationally representative comparison groups. The groups without any self reported mental or physical limitations, those with a limitation but who did not need daily living assistance, and those who did need assistance with daily living.

The researchers evaluated access to medical care through self-reported survey answers from individuals and how they obtained care and primary care services. Also, the number of emergency department visits was also self-reported.

To address this disparity, the researchers recommend the need for better communication between emergency departments and primary care physicians along with more information from tailored prevention and primary care programs.

In addition, the authors reported in the study that prevention and chronic condition management programs tailored for the functional limitations and service needs of people with disabilities may help avoid a crisis situation that would call for an urgent care visit. The authors endorsed wider adoption of coordinated care systems for the disabled that would provide case management, integration of psychosocial care and 24/7 access for medical assistance among other services.

Go to to hear from Rasch on the research and her findings.