There has been a longstanding concern that people with learning disabilities receive lower quality hospital care. The government report ‘Health Care for All’ concluded substandard care resulted in increased mortality and morbidity among those with learning disabilities. Despite such a firm conclusion, the number of studies investigating this is very small.
In order to strengthen the evidence base, researchers led by Dr Marcus Redley from the Cambridge Intellectual & Developmental Disabilities Research group undertook a study to investigate if people with learning disabilities indeed receive lower quality care.
The authors conducted a secondary data-analysis and looked at all the 30-day emergency readmissions in a single acute hospital in the East of England over the course of a year (a total of 7,408 readmissions).
‘This was a simple and elegant study, funded by ACT, which has helped to further an ongoing collaboration between the hospital and the Department of Psychiatry.‘, according to Dr Redley.
Emergency readmissions within thirty days of discharge are considered to be potential markers of poor care, as they are often for the same condition as the original admission, and it was thought that this might indicate that the patient had been discharged too early. Emergency readmissions within seven days were analysed seperately as a subgroup of this, as readmission as an emergency case within such a short period of time is seen as a clearer indicator of poor care.
The study group used Hospital Episode Statistics (HES) to do this.These statistics are routinely collected, contain data on reason for admission, and include indications if someone has a known learning disability.
The authors identified all the 30-day and 7-day emergency readmissions for those with learning disabilities, and subsequently collected demographic and clinical details to assess if the readmission was potentially preventable.
They found no significant difference in rates of both 30-day and 7-day readmissions, so those with learning disabilities were not considered more likely to be readmitted as an emergency than the general population. However, they did find that a large proportion (69%) of readmissions for those with learning disabilities was potentially preventable. In the general population, this percentage is estimated to be 23%. It is however difficult to compare rates from different studies, as it is not always clear which readmissions are preventable.
It also appeared that those with more severe learning disabilities were more likely to be readmitted, but the authors were unable to draw any firm conclusions on this. This is in part because the sample size was small (so there were simply not enough readmissions to say with enough certainty if it is the case), but also because the care for people with severe learning disabilities can be very complex and this might play a role in higher rates of readmission.
There are some limitations to the study: the authors only assessed statistics from one hospital (which might not be representative of all hospitals), and HES are known to have some limitations. One such limitation is that not every learning disability will be recorded, and also that the recorded assessment of severity might be unreliable. Finally, the rate of emergency readmissions is only a proxy marker of poor quality care; someone who isn’t readmitted can still receive poor quality care, and someone who is readmitted may have received very good care.
So, rather than to conclude that there is no evidence to support that those with learning disabilities experience poorer quality care, the authors point to the need for more research into this area. Claire Kelly, the lead author and one of the researchers involved in the study, states that:
‘Our research signals that there is further work to be done to ensure that all adults with learning disabilities receive safe and high quality hospital care. It also contributes to the evidence-base surrounding the use of acute secondary health services by these men and women, which is currently very limited. We therefore hope that our findings will be used to inform the planning and delivery of hospital care pathways which actively eliminate the barriers to service access experienced by this population.’