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Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment.

Carey, IM; Hosking, FJ; Harris, T; DeWilde, S; Beighton, C; Shah, SM; Cook, DG (2016) Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment. Journal of Epidemiology & Community Health, 71 (1). pp. 52-58. ISSN 1470-2738 https://doi.org/10.1136/jech-2016-207557
SGUL Authors: Carey, Iain Miller Cook, Derek Gordon De Wilde, Stephen Harris, Teresa Jane Hosking, Fay Julie Beighton, Carole Ann

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Abstract

BACKGROUND: Annual health checks for adults with intellectual disability (ID) have been incentivised by National Health Service (NHS) England since 2009, but it is unclear what impact they have had on important health outcomes such as emergency hospitalisation. METHODS: An evaluation of a 'natural experiment', incorporating practice and individual-level designs, to assess the effectiveness of health checks for adults with ID in reducing emergency hospital admissions using a large English primary care database. For practices, changes in admission rates for adults with ID between 2009-2010 and 2011-2012 were compared in 126 fully participating versus 68 non-participating practices. For individuals, changes in admission rates before and after the first health check for 7487 adults with ID were compared with 46 408 age-sex-practice matched controls. Incident rate ratios (IRRs) comparing changes in admission rates are presented for: all emergency, preventable emergency (for ambulatory care sensitive conditions (ACSCs)) and elective emergency. RESULTS: Practices with high health check participation showed no change in emergency admission rate among patients with ID over time compared with non-participating practices (IRR=0.97, 95% CI 0.78 to 1.19), but emergency admissions for ACSCs did fall (IRR=0.74, 0.58 to 0.95). Among individuals with ID, health checks had no effect on overall emergency admissions compared with controls (IRR=0.96, 0.87 to 1.07), although there was a relative reduction in emergency admissions for ACSCs (IRR=0.82, 0.69 to 0.99). Elective admissions showed no change with health checks in either analysis. CONCLUSIONS: Annual health checks in primary care for adults with ID did not alter overall emergency admissions, but they appeared influential in reducing preventable emergency admissions.

Item Type: Article
Additional Information: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Keywords: Epidemiological methods, Health inequalities, LEARNING DISABILITY, Epidemiology, 1117 Public Health And Health Services, 1604 Human Geography
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: Journal of Epidemiology & Community Health
ISSN: 1470-2738
Language: ENG
Dates:
DateEvent
16 June 2016Published Online
25 May 2016Accepted
9 December 2016Published
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
12/64/154National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
PubMed ID: 27312249
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/107930
Publisher's version: https://doi.org/10.1136/jech-2016-207557

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