Attrition from specialised rehabilitation associated with an elevated mortality risk: results from a vital status tracing study in Swiss spinal cord injured patients

BMJ Open, 2020 · DOI: 10.1136/bmjopen-2019-035752 · Published: January 1, 2020

Spinal Cord Injury Rehabilitation Public Health

Simple Explanation

Clinic attrition, where individuals experience irregular or discontinued care, is common among people with chronic health conditions. This can lead to higher risks of premature mortality and adverse health outcomes. This study aimed to identify risk factors for clinic attrition and evaluate the potential differential risk in mortality between those lost to clinic (LTC) compared with those with continued care in Swiss-based SCI-specialized rehabilitation centers. The study found that for individuals with traumatic SCI, going lost to clinic was associated with a nearly fourfold higher risk of mortality.

Study Duration

Not specified

Participants

1924 individuals with spinal cord injury

Evidence Level

Not specified

Key Findings

1
LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI.
2
Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI.
3
Younger ages were associated with a lower risk of LTC, with a more than twofold reduction in risk for younger individuals between 16 and 30 years of age (HR=0.44; 95% CI 0.31 to 0.64) and 31 and 45 years of age (HR=0.46; 95% CI 0.32 to 0.67) in comparison with 61–75 year olds.

Research Summary

This is the first study to our knowledge that has investigated LTC in the context of spinal cord injury, and the first to investigate the consequences of LTC in the broader Swiss setting. The key insight emerging from this study is that LTC in persons living with TSCI may be indicative of an elevated risk of death. Patterns of LTC may help illuminate risk factors for attrition from specialised care and consequently aid in identifying higher risk groups requiring targeted care to improve health outcomes and reduce premature mortality.

Practical Implications

Targeted Interventions

Identify and target high-risk groups (e.g., older individuals with incomplete lesions, those living far from specialized facilities) to improve health outcomes and reduce premature mortality.

Continuity of Care Improvement

Develop strategies to improve continuity of care in specialized rehabilitation centers, focusing on regular, life-long follow-up for the long-term management of secondary health conditions.

Healthcare Access

Address barriers to healthcare access, such as transportation, to ensure that individuals with SCI, particularly those with NTSCI, can receive timely and appropriate specialized care.

Study Limitations

1
The data used for this study include augmented information from a follow-up study meant to ascertain detailed vital status information
2
Another potential limitation is that to be eligible for analyses, it was required that VS first be checked in medical records.
3
Another potential, unmeasured confounder are secondary health conditions.

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