Using all-payer claims data for health surveillance of people with intellectual and developmental disabilities.

BACKGROUND: To address limitations and challenges associated with current health surveillance of people with intellectual and developmental disabilities (IDD), this study investigates the use of all-payer claims data to identify and characterise this population. METHOD: All-payer claims data from 2010 to 2014 were used to study people with IDD in New Hampshire. Starting with the Centers for Medicare and Medicaid Services' algorithm, IDD was defined using ICD-9 diagnosis codes. Additional ICD-9 codes for developmental disabilities were included to build the knowledge base begun by recent research conducted on Medicaid claimants in five other states. RESULTS: Findings showed the enhanced algorithm offers a replicable and feasible way to conduct health surveillance of people with IDD at the state level. CONCLUSION: Substantive and significant differences between Medicaid and commercial claimants suggest that using all-payer claims provides a richer and more complete method for health surveillance of people with IDD.

Levels and sources of sound in the intensive care unit - an observational study of three room types.

BACKGROUND: Many intensive care unit (ICU) patients describe noise as stressful and precluding sleep. No previous study in the adult setting has investigated whether room size impacts sound levels or the frequency of disruptive sounds. METHODS: A-frequency S-time weighted equivalent continuous sound (LAS eq), A-frequency S-time weighted maximum sound level (LAS max) and decibel C peak sound pressure (LC peak) were measured during five 24-h periods in each of the following settings: three-bed room with nursing station (NS) alcove, single-bed room with NS alcove (1-BR with NSA) and single-bed room with bedside NS. Cumulative restorative time (CRT) (> 5 min with LAS max < 55 dB and LC peak < 75 dB) was calculated to describe calm periods. Two 8-h bedside observations were performed in each setting in order to note the frequency and sources of disruptive sounds. RESULTS: Mean sound pressure levels (LAS eq) ranged between 52 and 58 dBA, being lowest during night shifts. There were no statistically significant differences between the room types in mean sound levels or in CRT. However, disruptive sounds were 40% less frequent in the 1-BR with NSA than in the other settings. Sixty-four percent of disruptive sounds were caused by monitor alarms and conversations not related to patient care. CONCLUSIONS: Single-bed rooms do not guarantee lower sound levels per se but may imply less frequent disruptive sounds. Sixty-four percent of disruptive sounds were avoidable. Our findings warrant sound reducing strategies for ICU patients.

Perspectives of dentists, families, and case managers on dental care for individuals with developmental disabilities in Kansas.

The status of dental care for individuals with developmental disabilities in Kansas was examined. Dentists, family members, and case managers reported general, but partial, satisfaction with the availability, accessibility, appropriateness, and affordability of such care. Reasons for the results and recommendations for further improvement are discussed.