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Adult medicaid beneficiaries with developmental disabilities and epilepsy: profiles of service use and costs
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Title
Adult medicaid beneficiaries with developmental disabilities and epilepsy: profiles of service use and costs
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Knox
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Michael
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Michael Knox
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author
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Crystal
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Stephen
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Advisory Committee
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Stephen Crystal
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chair
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Huang
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Chien-Chung
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Advisory Committee
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Chien-Chung Huang
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internal member
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Prince
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Jonathan
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Advisory Committee
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Jonathan Prince
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internal member
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Sambamoorthi
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Usha
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Advisory Committee
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Usha Sambamoorthi
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outside member
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Robert
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Advisory Committee
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Robert C. Like
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outside member
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Rutgers University
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Graduate School - New Brunswick
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theses
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2008
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2008-01
Language
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English
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electronic
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application/pdf
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viii, 190 pages
Abstract
Adults with developmental disabilities -- serious chronic impairments that begin in childhood and continue through the lifespan -- are a vulnerable population whose disabilities significantly affect their lives and who typically require lifelong supports (Aday, 1993; Developmental Disabilities Assistance and Bill of Rights Act of 2000, P.L. 106-402). This research analyzed eligibility and claims files of 9,303 community-dwelling adult Medicaid beneficiaries ages 21-64 that were enrolled with the NJ Division of Developmental Disabilities. Using an adapted Behavioral Model for Vulnerable Populations (Gelberg, Andersen, & Leake, 2000) as a conceptual framework, the study identified characteristics associated with epilepsy and addressed the impact of epilepsy on health service use and expenditures. It also identified patterns of epilepsy-related generalist and specialist physician care and examined the association of individual characteristics and patterns of physician care with health care use and expenditures.
Adult Medicaid beneficiaries with developmental disabilities and epilepsy were more likely than those without epilepsy to have one or more developmental disability diagnoses other than epilepsy, psychiatric comorbidity, and physical comorbidity. Individuals with epilepsy were more likely than those without epilepsy to have an inpatient admission and to have an emergency room visit. Epilepsy also was associated with higher annual expenditures. Among those with epilepsy, African Americans were less likely than whites to have an epilepsy-related specialist visit. Individuals with Medicare and Medicaid coverage were much less likely to have an epilepsy-related emergency room visit than individuals with Medicaid only.
Study results can inform policy makers and practitioners in state developmental disabilities and Medicaid agencies as well as other professionals who assist people with developmental disabilities and their families in accessing medical care. Access to an appropriate health provider should be a priority of developmental disability case managers, care givers, and residential providers as well as state health care policy makers. The apparent disparity in access to epilepsy-related specialist care also underscores the need for state initiatives to ensure equitable access to care. Moreover, findings regarding comorbidities and increased hospital use by those with epilepsy suggest a need to explore approaches for better management of epilepsy, including coordination between generalist and specialist care.
Adult Medicaid beneficiaries with developmental disabilities and epilepsy were more likely than those without epilepsy to have one or more developmental disability diagnoses other than epilepsy, psychiatric comorbidity, and physical comorbidity. Individuals with epilepsy were more likely than those without epilepsy to have an inpatient admission and to have an emergency room visit. Epilepsy also was associated with higher annual expenditures. Among those with epilepsy, African Americans were less likely than whites to have an epilepsy-related specialist visit. Individuals with Medicare and Medicaid coverage were much less likely to have an epilepsy-related emergency room visit than individuals with Medicaid only.
Study results can inform policy makers and practitioners in state developmental disabilities and Medicaid agencies as well as other professionals who assist people with developmental disabilities and their families in accessing medical care. Access to an appropriate health provider should be a priority of developmental disability case managers, care givers, and residential providers as well as state health care policy makers. The apparent disparity in access to epilepsy-related specialist care also underscores the need for state initiatives to ensure equitable access to care. Moreover, findings regarding comorbidities and increased hospital use by those with epilepsy suggest a need to explore approaches for better management of epilepsy, including coordination between generalist and specialist care.
Note
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Ph.D.
Note
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Includes bibliographical references (p. 177-188).
Subject
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Topic
Social Work
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Topic
Developmentally disabled--Services for
Subject
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Topic
Medicaid
Subject
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Topic
Epileptics--Services for
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Graduate School - New Brunswick Electronic Theses and Dissertations
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rucore19991600001
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http://hdl.rutgers.edu/1782.2/rucore10001600001.ETD.17145
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ETD_715
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doi:10.7282/T3028RX1
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ETD doctoral
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Rights
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The author owns the copyright to this work.
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Open
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Name
Michael Knox
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Rutgers University. Graduate School - New Brunswick
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Non-exclusive ETD license
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I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
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