Inﬂuence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States

North American Spine Society Journal, 2022 · DOI: https://doi.org/10.1016/j.xnsj.2022.100186 · Published: November 25, 2022

Spinal Cord Injury Trauma Public Health

Simple Explanation

This study investigates whether socioeconomic factors affect where patients go after being discharged from the hospital following a traumatic spinal cord injury (SCI). It looks at whether factors like insurance status influence the likelihood of being discharged to rehabilitation facilities. The research found that uninsured patients are less likely to be discharged to acute rehabilitation or skilled nursing facilities after surgery for SCI, suggesting that the cost of these services may be a barrier. The study also found that patients with Medicare, major psychiatric disorders, or more severe injuries are more likely to be discharged to non-home healthcare facilities.

Study Duration

2012-2016

Participants

3933 patients with cervical or thoracic spine fracture with spinal cord injury

Evidence Level

Cohort analysis

Key Findings

1
Uninsured patients are less likely to be discharged to acute rehabilitation or alternative healthcare facilities following surgical management of SCI.
2
Patients insured by Medicare were more likely to have a non-home discharge (OR = 1.45 [1.08-1.96], p = .015).
3
Patients in the Southern United States are significantly less likely to be discharged to another healthcare or rehab facility following SCI.

Research Summary

Uninsured patients are less likely to be discharged to acute rehabilitation or alternative healthcare facilities following surgical management of SCI. High out-of-pocket costs for uninsured patients in the United States may deter utilization of these services. This study analyzed a national trauma database finding that there may be barriers to care for patients without insurance post-SCI. Patients with Medicare have higher odds of non-home discharge. First, Medicare patients, by deﬁnition, are older and therefore may require more assistance to regain their functional independence.

Practical Implications

Policy Implications

The findings suggest a need for policies that address the financial barriers preventing uninsured patients from accessing rehabilitation services after SCI.

Clinical Practice

Healthcare providers should be aware of the disparities in discharge disposition and advocate for equitable access to post-acute care for all patients, regardless of insurance status.

Further Research

Future studies should explore the efficacy of interventions like community health center programs and patient navigators in improving healthcare access for uninsured individuals.

Study Limitations

1
The NTDB lacks data granularity specifically regarding the type of spine fracture and SCI severity (e.g., American Spinal Injury Association, or ‘ASIA,’ classiﬁcation).
2
The NTDB does not contain an ideal set of variables to objectively assess in which instances non-home discharge was indicated and justified and in which cases home discharge would have been appropriate.
3
The NTDB is a voluntary database prone to missing coding data leading to sampling bias.

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