Category: Health Services Research; Quality Improvement and Implementation Science
Objective : To test the hypothesis that enrollment in a primary care center designed for adults with autism, called the Center for Autism Services and Transition (CAST), would be associated with reduced emergency department (ED) utilization over time.
Design : Retrospective longitudinal cohort study using repeated measures, mixed-effects, negative binomial regression.
Setting : Academic medical center.
Participants (or Animals, Specimens, Cadavers) : 77 CAST patients with ≥1 ED visit (58 men; median baseline age 22 years; 47 with intellectual disability).
Interventions : CAST was co-developed with providers, caregivers, and adults with autism to overcome barriers to care by providing accommodations to the standard patient flow.[1]
Main Outcome Measure(s) :
Number of ED visits per year for: any reason (all-cause); non-emergent conditions; and mental health conditions. ED visits for non-emergent and mental health conditions were defined using the New York University ED visit algorithm, which classifies visits on the basis of the primary diagnosis code.[2] Demographic covariates were: sex, race, age, Medicare, co-occurring intellectual disability, and zip code.
Results : After controlling for demographics, each year of CAST enrollment was associated with a 33% reduction in ED visits for any reason (IRR=0.67, 95% CI=0.57-0.84) and 31% reduction in ED visits for mental health conditions (IRR=0.69, 95% CI=0.51-0.94). Each year of treatment through CAST was associated with a 26% reduction in non-emergent ED visits, but this finding did not reach statistical significance (IRR=0.74, 95% CI=0.51-1.08).
Conclusions : With inadequate primary care, adults with autism may over-utilize ED services and under-utilize preventive care.[3] Findings provide preliminary support for the effectiveness of CAST for reducing reliance on the ED over time. Future studies will examine how CAST can facilitate reduced reliance on the ED for non-emergent conditions.
Elizabeth Koss Schmidt
– PhD Candidate, The Ohio State University, Columbus, OhioAmy Hess
– Program Director, Center for Autism Services and Transition, Columbus, OhioChristopher Hanks
– Physician and Medical Director, Center for Autism Services and Transition, Columbus, Ohio
Brittany Hand
– Assistant Professor, The Ohio State University, Columbus, Ohio