Tuesday, January 08, 2013 Coordinated Care May Address Emergency Department Use by Adults With Disabilities Working-age adults with disabilities account for a disproportionately high amount of annual emergency department visits, reports a comparison study from National Institutes of Health (NIH) researchers. The NIH study analyzed pooled data from the Medical Expenditure Panel Survey. Researchers found access to regular medical care, health profile complexity, and disability status contributed to people with disabilities' use of the emergency department. Despite representing 17% of the working age US population, the study found that adults with disabilities accounted for 39.2% of total emergency department visits. Those with a severely limiting disability visited an urgent care department more often than their peers and were more likely to visit the emergency department more than 4 times per year. Emergency visits also were associated with poor access to primary medical care, which was more prevalent among adults with disabilities. "We want to understand what takes people to the emergency department to learn if their care could be better managed in other ways," said Elizabeth Rasch, PhD, chief of the Epidemiology and Biostatistics Section in the NIH Clinical Center's Rehabilitation Medicine Department. "While many of those visits may be necessary, it is likely that some could be avoided through better information sharing among all of the health care providers who see a particular individual." The authors make recommendations for providers and policymakers to offset some of the need for emergency care by individuals with disabilities. Prevention and chronic condition management programs tailored for the functional limitations and service needs of people with disabilities may help avoid a crisis situation that would call for an urgent care visit, the report noted. The authors also endorsed wider adoption of coordinated care systems for people with disabilities that provide case management, integration of psychosocial care, and 24/7 access to medical assistance, among other services. Free full text of the study is available online in Health Services Research. Physical therapists (PTs) are increasingly being asked to provide evaluation and management of patients in the emergency department. As part of the emergency department team, PTs have the opportunity to collaborate in the care of patients with a wide range of acute and chronic problems coming from the neuromusculoskeletal, cardiovascular/pulmonary and integumentary systems. PTs in this setting also serve a critical role in screening for appropriateness of care, consultation with other practitioners, and in the direct care of patients. For more information about this expanding area of practice, visit APTA's Physical Therapist Practice in the Emergency Department webpage, which includes a toolkit designed to help PTs initiate the development of a PT practice in an emergency department.