Examining health-care utilization in the first year following spinal cord injury

The Journal of Spinal Cord Medicine, 2015 · DOI: 10.1179/2045772314Y.0000000269 · Published: January 1, 2015

Spinal Cord Injury Healthcare Rehabilitation

Simple Explanation

This study looked at how people with spinal cord injuries use healthcare services in the first year after they leave the hospital. It examined things like hospital readmissions, visits to doctors, and the use of home healthcare. The study found that people with more severe spinal cord injuries, especially those with tetraplegia (affecting all four limbs), tended to use more healthcare services. Also, people who were not discharged home directly from the hospital used more services. The study also found that falls as a cause for SCI was associated with lower use of in-home services. The most common reasons for hospital readmission were urinary tract infections and respiratory conditions.

Study Duration

1 year

Participants

168 adults with traumatic spinal cord injury

Evidence Level

Prospective cohort

Key Findings

1
Individuals with greater neurological impairment (C1–4 AIS A–C) or those not discharged home after inpatient rehabilitation had higher health-care utilization in the first year following discharge.
2
The most common diagnoses associated with re-hospitalization in the first year after inpatient rehabilitation were genitourinary causes, including urinary tract infection (35%), followed by respiratory conditions (12%).
3
SCI due to falls (vs. vehicular crashes) was associated with lower use of in-home services.

Research Summary

The study aimed to identify factors associated with health-care utilization during the first year after inpatient rehabilitation in individuals with traumatic spinal cord injury. Health-care utilization in the first year following IR was high with 45% of subjects reporting re-hospitalization. Twenty percent of patients were initially discharged to a skilled nursing facility (SNF), and an additional 10% required SNF care during this first year. Those with greater neurological impairment or not discharged home after IR had higher health-care utilization, while age was not associated with utilization. Targeted efforts to reduce genitourinary and respiratory complications may reduce the need for hospital care in the first year after IR.

Practical Implications

Targeted Interventions

Targeted efforts to reduce genitourinary and respiratory complications may reduce the need for hospital care in the first year after IR.

Comprehensive Discharge Planning

Comprehensive, coordinated IR discharge, and follow-up planning is needed, especially for individuals with high tetraplegia.

Standardized Discharge Planning

Rates of re-hospitalization and ER visits could be reduced by specific interventions such as standardized discharge planning (especially for those discharging to a SNF).

Study Limitations

1
Data from this study were collected from a single hospital system from one region of the USA and may not be generalizable more broadly to the entire country.
2
The use of a self-report method may have introduced recall bias.
3
Data on medical co-morbidities was not collected, it may have explained some of the variance in health-care use.

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