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Statement of Problem
Choosing Home and Emergency Department Use was an exploratory study that examined
the relationship between people with IDD and where they would choose to live and emergency
department utilization (2020). People with intellectual disabilities, when not given the option to
choose where and with whom to live, received increased emergency department visits. By
allowing individuals with disabilities the option to choose where they can live and with whom
they reside with, their health outcome may improve, resulting in less emergency visits. This
study, conducted in 2020, used quantitative data along with a random sampling to determine
whether those with intellectual disabilities that decided where they lived would receive better
health outcomes, and fewer emergency department visits.
Research Question
What is the relationship between people with IDD choosing their residence and
emergency department utilization (Friedman, 2020)?
Methods
This study was a secondary data analysis, using data collected from randomly selected
adults receiving services from a state developmental disabilities department. The study collected
data from 251 people with IDD that participated in a Personal Outcome Measures interview in
2018. Data was also collected in 2018 from emergency department visits for that sample of
individuals. This sample included a majority of white men with an average age of 47, with most
participants residing in provider owned homes. When choosing the individuals based on
disability, there was a measure of mild, moderate, severe, and profound, with the majority of
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individuals falling within a mild disability. The dependent variable of this study was the amount
of emergency department visits in 2018, regardless of severity.
When gathering the results from this data, Friedman used a “negative binomial model”
that examined the relationship between department visits, and the ability to choose residences,
impairment severity, and residence type (Friedman, 2020). This type of model is used to analyze
quantitative data such as the amount of times an individual visited the emergency department.
Results
According to the data, about 33 of the 251 participants chose where they would live,
while 218 of them did not, and the number of emergency room visits averaged about 1.35 per
person. With the negative binomial analysis, it was concluded that emergency department visits,
choosing where and with whom to live, and participant demographics had a significant
relationship (Friedman, 2020). Ultimately Friedman shows that those with intellectual disabilities
that were allowed to choose their residence, had a 74.23 decrease in emergency department visits
(2020).
It was also noted in this study, that the level of intellectual disabilities did not play a role
in the relationship with residency and emergency department visits.. When keeping variables
constant there were significant increases for individuals with complex needs, not based on age,
decision making authority, or residence type. These results indicate, when given the choice,
individuals with disabilities reduce their health inequities, ultimately reducing the amount of
emergency department visits.
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Reflection
This research is beneficial for those with IDD, due to the fact that theyHave experienced
a history of denial to the opportunity to choose where they live as well as segregation. by
conducting the study new rules and regulations can begin to exist to expand options and improve
outcomes for those with intellectual disabilities. by allowing them to choose where to live and
with whom they can live with can improve emergency department utilization and
cost-effectiveness.
With this 74% decrease in visits to an emergency department for people with intellectual
disabilities, allowing them to choose where they live and the type of residency they have, people
with intellectual disabilities will have improved health outcomes. Although this study is just a
stepping point, it opens the door for increased research opportunities as it has already proven
beneficial with a decrease in emergency department visits for those with intellectual disabilities.
Further research should dive deeper into the varying levels of disability needs. As stated
in this study, averages were concluded when evaluating the data. It may be beneficial for those
individuals to better understand each level of severity and what choosing residency means for
their health equity. It would also be beneficial to expand this research, as this study was
conducted in a single state and was evaluated as a secondary data analysis. There may be
differences of residence types that impact choice, and varying differences in people’s emergency
services during their visits.
As those living without disabilities, the idea of not being allowed the choice of where to
live is foreign to us. However, where someone lives is a determinant of health, and social quality
of life. By allowing individuals with disabilities the opportunity to choose where they live,
allows them to have a better quality of life, giving them the opportunity to seek more
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References
Friedman, C. (2019b). The move to managed care for intellectual and developmental disability
services: Guidance for state Medicaid and DD Directors, and Payers. CQL | The Council
on Quality and Leadership.
https://www.c-q-l.org/resources/guides/the-move-tomanaged-care-for-idd-services-guidan
ce-for-state-medicaid-and-dd-directors-and-payers/
Friedman, C. (2021). Choosing Home: the impact of choosing where to live on people with
intellectual and developmental disabilities’ emergency department utilization. Inclusion,
9(2), 92–103. https://doi.org/10.1352/2326-6988-9.2.92
