Background: Prolonged hospitalization is associated with increased risk of complications. Patients with intellectual and developmental delay (IDD) are overall more likely to seek hospital care for chronic conditions, more likely to be admitted and more likely to have extended hospitalizations. While inpatient length of stay (LOS) and readmission rates among patients with IDD have been well characterized in Canada and the United Kingdom, there is limited published data on these outcomes in the United States. Consequently, the problem of disproportionately prolonged hospitalization among this population remains inadequately understood and addressed.
Purpose: Individuals with IDD have increased healthcare needs and costs compared to non-disabled patients. They also have poorer health outcomes. Among many barriers to appropriate care is lack of IDD specific care. A pilot intervention in an academic hospital system in NJ is addressing this gap with the creation of a multidisciplinary IDD specific care coordination team. The team builds individualized care plans which are easily accessible across the system through the EMR. These plans improve the quality of care delivered to patients with IDD which will lead to improvement in metrics such as LOS, patient satisfaction, behavioral disruption, and readmission rates with their implementation.
Description: Patients who meet WHO criteria for IDD are eligible for the program. Once registered, an individualized care plan is created and documented in a Care Coordination note. Extensive social history, communication practices, functional status, and behavioral considerations such as triggers and de-escalation techniques are outlined. Plans are collaboratively created by the patient, care givers, and a behavioral specialist. The IDD team receives daily alerts of patient encounters. Planned procedures and admissions are then discussed at a weekly complex care meeting. Each case is reviewed to identify needs that can be addressed proactively. Potential discharge barriers and risks for behavioral disruptions are also addressed. Plans are then communicated to the primary team. The IDD team follows along during admission and serves as a resource for patients and their care teams. Unplanned admissions are addressed in real time. The behavioral specialist contacts the patient, care giver, and primary team within 24 hours of admission. They are available to assist with behavioral disruption, care coordination and transitions of care.
Conclusions: This innovative program addresses the many healthcare barriers faced by patients with IDD. The program is in its early deployment, but early hospital data is promising, particularly for length of stay. Review of summary LOS data for program participants in the year following implementation of patient specific care plans revealed a significant decrease in length of stay (6.8 vs 5.4 days) in our acute tertiary care center. We will continue to track LOS in addition to metrics such as readmission rates, behavioral rapid response (BRRT) rates, and patient experience scores. We anticipate continued improvement in LOS, a decrease in behavioral events, and a reduction in readmission rates.