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Emergency Department Visits to Sunnybrook Hospital by Adults With Developmental Disabilities and Aging Adults Without Disabilities

Applied Health Research Question submitted by Sunnybrook Hospital
Authors: Yona Lunsky, Ph.D. & Jacques Lee, MD

Background

Adults with developmental disabilities are potentially high users of health care resources. Previous research has shown high rates of preventable hospitalizations among adults with developmental disabilities. However, their rates of emergency department use, in comparison to other high risk groups, are currently unknown.

Purpose

The purpose of this report was to better understand two types of frequent health care users: adults with developmental disabilities aged 18 to 64 years and adults without developmental disabilities aged 65 years and older.

Methods

Using health and social services administrative data, 66,484 Ontario adults with developmental disabilities aged 18 to 64 years and 557,609 Ontario adults without developmental disabilities aged 65 years and older were identified. Of these, 206 adults with developmental disabilities and 2,978 older adults without developmental disabilities had at least 1 visit to the Sunnybrook Hospital Emergency Department in the 2009 fiscal year.

Results

  • Among emergency department users, adults with developmental disabilities were more likely than older adults without developmental disabilities to be male and to fall in the lowest neighbourhood income quintile.
  • Adults with developmental disabilities, despite being 40 years younger (on average), had similar levels of morbidity compared to older adults without developmental disabilities.
  • Adults with developmental disabilities were more likely to have mental health problems and asthma but were less likely to have hypertension, diabetes mellitus, and chronic obstructive pulmonary disease.
  • The overall patterns of Canadian Triage and Acuity Scale scores were similar for both groups. However, emergent visits were more common among older adults without developmental disabilities.
  • The most common presentations for both groups were injuries and abnormal findings.
  • Adults with developmental disabilities were more likely to have had five or more emergency department visits in the year of study than older adults without developmental disabilities.
  • Following discharge, adults with developmental disabilities were more likely to have another emergency department visit within 30 days.

Conclusions and Implications

Patients with developmental disabilities presenting to the Sunnybrook emergency department were similar in many ways to those without developmental disabilities over 65 years of age, despite being, on average, nearly 40 years younger. Sunnybrook is a member of the North East Toronto Health Link which works to improve coordination of care for patient groups that are high users of the healthcare system. Adults with developmental disabilities are a group for which Health Link interventions may be appropriate to reduce recurrent emergency department visits and to provide better, more efficient integrated care.