Health Care Utilization Patterns of Adults with Autism Spectrum Disorder in a Safety-Net Hospital

Background: Autism Spectrum Disorder (ASD) has become increasingly prevalent with the most recent CDC data stating that 1 in 59 children aged 8 years have been diagnosed with ASD (Baio, 2018). Despite the increasing prevalence of autism, there are few published studies analyzing healthcare utilization patterns in adults with autism. Based on data from Kaiser Permanente, Zerbo et al. compared healthcare utilization and costs among adults with ASD, adults with ADHD, and adults with neither condition (Zerbo et al 2018), and found that the utilization and costs of healthcare services among adults with ASD are higher than adults with ADHD or adults with neither ADHD nor ASD (Zerbo et al 2018). We aimed to better understand the utilization patterns for adults with autism in a safety-net hospital.

Objectives:

This study aims to identify the utilization patterns of different healthcare services among adults with ASD at Boston Medical Center (BMC).

Methods: The study population was retrieved from the clinical data warehouse of Boston Medical Center (BMC), which contained BMC patient data only. Adults 23 years of age and up at the time of any medical encounter were eligible for inclusion. Patients flagged with autism codes ICD-9 ([ICD-9 299.0] Autistic disorder; [ICD-9 299.1] Childhood disintegrative disorder; [ICD-9 299.8] Asperger’s disorder; [ICD-9 299.9] Pervasive developmental disorder) and ICD-10 codes ([ICD-10 F84] Pervasive developmental disorder; [ICD-10 F84.0] Autistic disorder; [ICD-10 F84.2] Rett’s syndrome; [ICD-10 F84.3] Other childhood disintegrative disorder; [ICD-10 F84.5] Asperger’s disorder; [ICD-10 F84.8] Other pervasive developmental disorders; [ICD-10 F84.9] Unspecified pervasive developmental disorder) in the past ten years on either the problem list or the encounter were extracted from the database, and their encounters at BMC during 2017 were further retrieved as the sample data. The study included 304 adult patients, who made a total of 1,953 visits to BMC in 2017.

Results:

Of the 304 adult patients, 73 patients visited BMC once, and 64 patients visited twice in 2017. 62 adult patients had 10 or more encounters at BMC, and 2 had over 60 encounters. The total 1,953 encounters were broken down into four different visit types: outpatient (86%), inpatient (2%), emergency (10%) and other (2%). “Other” includes: observation, pre-admit, pre-clinic, recurring, and same day care visits. In addition, we identified the top 5 most frequently visited departments by number of encounters as follows: Psychiatric Clinic (227), Adult Emergency Department (180), Primary Care (152), Social Service Office (118), and Family Medicine (110).

Conclusions:

The average number of encounters per patient is 6.4, and 20% of the adult patients had 10 or more encounters in 2017. The most frequently visited departments were Psychiatry Clinic, Adult Emergency Department, and Primary Care. This information is helpful in informing efforts aimed at better supporting adults with ASD.