Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment.
Annual health checks for adults with intellectual disability (ID) have been incentivised by National Health Service (NHS) England since 2009, but it is unclear what impact they have had on important health outcomes such as emergency hospitalisation.



An evaluation of a 'natural experiment', incorporating practice and individual-level designs, to assess the effectiveness of health checks for adults with ID in reducing emergency hospital admissions using a large English primary care database. For practices, changes in admission rates for adults with ID between 2009-2010 and 2011-2012 were compared in 126 fully participating versus 68 non-participating practices. For individuals, changes in admission rates before and after the first health check for 7487 adults with ID were compared with 46 408 age-sex-practice matched controls. Incident rate ratios (IRRs) comparing changes in admission rates are presented for: all emergency, preventable emergency (for ambulatory care sensitive conditions (ACSCs)) and elective emergency.



Practices with high health check participation showed no change in emergency admission rate among patients with ID over time compared with non-participating practices (IRR=0.97, 95% CI 0.78 to 1.19), but emergency admissions for ACSCs did fall (IRR=0.74, 0.58 to 0.95). Among individuals with ID, health checks had no effect on overall emergency admissions compared with controls (IRR=0.96, 0.87 to 1.07), although there was a relative reduction in emergency admissions for ACSCs (IRR=0.82, 0.69 to 0.99). Elective admissions showed no change with health checks in either analysis.



Annual health checks in primary care for adults with ID did not alter overall emergency admissions, but they appeared influential in reducing preventable emergency admissions.
Population Health Research Institute, St George's University of London, London, UK.
Iain M
0000-0003-1099-8460
IM
Carey
Population Health Research Institute, St George's University of London, London, UK.
Fay J
FJ
Hosking
Population Health Research Institute, St George's University of London, London, UK.
Tess
T
Harris
Population Health Research Institute, St George's University of London, London, UK.
Stephen
S
DeWilde
Population Health Research Institute, St George's University of London, London, UK.
Carole
C
Beighton
Population Health Research Institute, St George's University of London, London, UK.
Sunil M
SM
Shah
Population Health Research Institute, St George's University of London, London, UK.
Derek G
DG
Cook
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008607:Intellectual Disability; D008297:Male; D008875:Middle Aged; D019989:Persons with Intellectual Disabilities / Q000706:statistics & numerical data*; D011320:Primary Health Care; D013222:State Medicine
Epidemiological methods; Health inequalities; LEARNING DISABILITY