The use of hospital care by people with intellectual disabilities in England

Problem

Healthcare providers have a responsibility to reliably identify people with intellectual disability (ID) and ensure that appropriate provision is made for them. A recent survey raised concerns regarding whether hospitals in England have adequate arrangements for identifying the people who need this care. This study aimed to identify the proportion of admitted patient care delivered to patients with ID by exploring patterns of use by people with and without ID.

Approach

Patients registered ≥1 day during 04/01/2010-03/31/2014 at an English GP practice contributing to the Clinical Practice Research Datalink and eligible for linkage with Hospital Episode Statistics were included in the study cohort. Patients were followed up to the end of the study period or censored when they left the GP practice. Patients with ID were identified via Read codes. Indirectly age-sex standardised ratios (ISR) for bed days were calculated by speciality with 95% confidence intervals (CI).

Findings

Over 11 million person-years were included in the study, including 59,247 (0.53%) attributable to people with ID. People with ID accounted for 0.89% of bed days, with proportions decreasing with age and varying across speciality. People with ID occupied over two and a half times the number of bed days compared to the whole population. Dentistry (ISR 11.2, CI 10.0-12.4), paediatric care (ISR 10.0, CI 9.8-10.2) and medical specialties (ISR 3.2, CI3.1-3.2) showed the highest excess rates.

Consequences

Rates of admitted patient care are higher for people with ID, with significant variation by age and speciality. This results in a higher proportion of bed days being occupied by patients with ID than the proportion of people with ID in the population. The results can guide healthcare providers wishing to audit the identification and care of people with ID.