Correlates for the risk of specialist ID hospital admission for people with intellectual disabilities: development of the LDNAT inpatient index

• Published in: Tizard learning disability review 2018-01, Vol.23 (1), p.42-50
• Main Authors: Painter, Jon, Ingham, Barry, Trevithick, Liam, Hastings, Richard P, Roy, Ashok
• Format: Article
• Language: English
• Subjects: Aggression; Behavior; Community Relations; Community services; Community support; Comparative Analysis; Departments; Epidemiology; Health behavior; Hospitalization; Hospitals; Indexes; Institutionalization; Intellectual disabilities; Intellectually disabled people; Interviews; Longitudinal Studies; Mental Disorders; Mental Health; Mental health care; Mental health services; National Standards; Needs Assessment; Patients; Persuasive Discourse; Psychiatry; Risk; Risk Assessment; Social Problems; Social Services
• ISSN: 1359-5474; 2042-8782
• DOI: 10.1108/TLDR-04-2017-0015

Purpose The purpose of this paper is to analyse ratings data from the recently developed Learning Disability Needs Assessment Tool (LDNAT) to identify factors associated with specialist intellectual disability (ID) hospital admissions. Design/methodology/approach Ratings from 1,692 individuals were analysed and the LDNAT items differing significantly between inpatients and non-inpatients were identified. Statistical analyses on total scores derived from these items were used to calculate an optimal cut-off. This LDNAT inpatient index score was also confirmed via an alternative statistical technique. Findings On average, 18 of the 23 LDNAT item ratings were significantly higher in people with ID assessed as inpatients compared to those rated in community settings. Using the total of these items, the resulting LDNAT inpatient index was analysed. A cut-off score of 22.5 was calculated to be the optimal balance between sensitivity (0.833) and specificity (0.750). This was confirmed by calculating the Youden index (j=0.583). At this level 68 per cent of inpatients and 81 per cent of non-inpatient cases were correctly identified. Practical implications Currently there is a national (UK) programme to radically reduce the amount of specialist inpatient care for people ID. This will necessitate early identification of individuals most at risk of admission together with investment in improved, proactive community services if admissions to a diminishing bed-base are to remain manageable. Originality/value This study confirms the associations between mental health difficulties, challenging behaviour and specialist hospital admissions for people with ID, extending existing research by translating these findings into a clinically usable risk index.