Reasons for rehospitalization in patients with spinal cord injury: 5 years' experience

Paker, Nurdan; Soy, Derya; Kesiktaş, Nur; Bardak, Ayşe Nur; Erbil, Metin; Ersoy, Sedef; Ylmaz, Hürriyet

doi:10.1097/01.mrr.0000185953.87304.2a

Cited by 49 publications

(40 citation statements)

References 17 publications

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“…1,2 To date, the majority of literature on SCI characterizing the incidence, impairments, demographics and health care utilization has largely focused on people with traumatic SCI (TSCI), with minimal research related to non-traumatic spinal cord injury (NTSCI) population. 3,4 NTSCIs are caused by a variety of medical conditions including but not limited to: vertebral spondylosis, tumor compression, vascular ischemia, neuronal motor disease, infectious abscess and transverse myelitis.…”

Section: Introductionmentioning

confidence: 99%

Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study

et al. 2009

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Study Design: Retrospective cohort design. Objectives: To compare socio-demographic, impairment characteristics and utilization (physician and emergency department (ED) visits) for non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury 1 year post inpatient rehabilitation. Setting: Ontario, Canada. Methods: Inpatient stays (2003)(2004)(2005)(2006) were identified from the National Rehabilitation Registry System. Exclusions were: in-hospital mortality; discharge after 31 March 2006; death within 1 year after discharge. Multivariate logistic regression analyses were used to determine factors predicting high utilization. Results: NTSCI cases (n ¼ 1002) were greater than TSCI (n ¼ 560). NTSCIs were older (mean ¼ 61.6, s.d. ¼ 15.8) with more co-morbidities, paraplegic (39.5%) and female (Po0.001). NTSCI had higher FIM admission and discharge scores but lower change scores. Mean number of physician visits for NTSCI and TSCI were 31.2 (median ¼ 24) and 29.7 (median ¼ 22), with no significant differences in mean specialist visits (NTSCI 16.5: TSCI 17.0). Factors predicting 30 or more physician visits included age 60 years or above (OR ¼ 1.5; 95% CI ¼ 1.2-1.9), urban living (OR ¼ 1.59; 95% CI ¼ 1.12-2.22) and lowest quartile (18-88) discharge FIM (OR ¼ 1.8; 95% CI ¼ 1.4-2.3). Charlson score of 3 or more (OR ¼ 2.1; 95% CI ¼ 1.3-3.2), urban living (OR ¼ 1.92; 95% CI ¼ 1.3-2.86) and lowest quartile discharge FIM (OR ¼ 1.5; 95% CI ¼ 1.2-2.0) were associated with 20 or more specialist visits. Factors for high ED use were: rurality (OR ¼ 1.5; 95% CI ¼ 1.1-2.1), low income (OR ¼ 1.4; 95% CI ¼ 1.1-1.9) and low (18-88) discharge FIM (OR ¼ 1.7; 95% CI ¼ 1.3-2.2). Conclusion: Both demonstrated significant health care utilization requiring attention to health care needs; particularly for those living in rural settings, with low income and/or low functional ability.

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Section: Introductionmentioning

confidence: 99%

Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study

et al. 2009

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“…Rehospitalization following spinal cord injury (SCI) has been studied in a number of countries including the United States, Canada, 1 Turkey, 2 Britain, the Netherlands, 3 Italy 4 and Australia (Table 1). 5 These studies have reported that approximately one-third of persons with a traumatic SCI will be rehospitalized each year.…”

Section: Introductionmentioning

confidence: 99%

“…Two, many are reporting on a single center or healthcare provider thereby limiting generalizability. 2,6,14 Three, some have relied on patient surveys and may be subject to recall bias. 4,7,9,12,15 Another issue affecting studies examining rehospitalization is the recency of the cohort.…”

Section: Introductionmentioning

confidence: 99%

Health system factors associated with rehospitalizations after traumatic spinal cord injury: a population-based study

et al. 2009

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Study design: This is a cohort study with 1-year follow-up. Objectives: The aim of this study was to examine 1-year rehospitalization rates following spinal cord injury (SCI) onset and health system factors affecting rehospitalization. Methods: All persons who had an acute care hospitalization for traumatic SCI in Ontario between 1 April 2003 and 31 March 2006 were identified according to International Classification of Diseases, Tenth Revision codes and followed for 1 year following acute care discharge through record linkage of administrative databases. Index cases with an SCI admission the year before 2003 as well as persons who died within 1 year after the index hospitalization were excluded from the analysis. Factors associated with 1-year rehospitalization were assessed using multivariate logistic regression analyses and included age, sex, rurality, length of stay, comorbidity, level of injury, discharge disposition, in-hospital complication, physician visits and specialist visits measure and etiology of injury. Results: A total of 559 individuals met the inclusion criteria and 27.5% (n ¼ 154) were rehospitalized 1 year after initial acute care discharge. Factors significantly associated with 1-year rehospitalization were length of stay, rural residence, 50 þ outpatient physician visits and 50 þ specialists visits following the index admission. The main causes of rehospitalization were musculoskeletal, respiratory, gastrointestinal and urological disorders. Conclusion: This study presents recent data on rehospitalization and yet rehospitalization rates continue to remain high. Our findings have significant implications for healthcare policy and planning in Ontario, Canada with respect to the management of SCI to achieve optimal health outcomes, in particular in rural areas.

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“…[1][2][3][4] In a 6-year follow-up study, Dryden et al 5 demonstrated that among individuals with SCI, 47.6% were treated for a urinary tract infection (UTI), 33.8% for pneumonia, 27.5% for depression and 19.7% for decubitus ulcer (either during initial hospitalization, a subsequent hospitalization or by a physician). A cross-sectional study from the US Model System conducted by Anson and Shepherd 6 determined that 95.6% of patients had at least one medical complication at the time of their routine annual checkup and between 28 and 35% of patients (depending on the level of injury) had a UTI and 22.4% had decubitus ulcers.…”

Section: Introductionmentioning

confidence: 99%

Physician utilization among adults with traumatic spinal cord injury in Ontario: a population-based study

et al. 2009

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Study design: Retrospective cohort study. Objectives: To describe the physician utilization patterns (family physicians (FP), specialist and emergency department (ED) visits) of adults with traumatic spinal cord injury (SCI) 1 year after the initial injury. Setting: Ontario, Canada. Methods: A total of 559 individuals with a traumatic SCI were identified. Five administrative databases were linked to examine health-care utilization in acute care, inpatient rehabilitation, chronic care rehabilitation, outpatient physician visits and ED visits. Factors predicting frequent physician, specialist and ED use were identified. Results: The mean number of physician visits for traumatic SCI patients during the first year after their injury onset was 31.7 (median 26). FPs had the greatest number of visits (mean 11.6, median 7) followed by physiatrists (mean 6.1, median 2). Factors predicting 50 or more physician visits included age 70 or above (OR ¼ 3.6, 95% CI ¼ 2.0-6.5), direct discharge to chronic care (OR ¼ 3.6, 95% CI ¼ 1.0-13.1) and in-hospital complication (OR ¼ 2.34, 95% CI ¼ 1.3-4.3). Age 70 or less (OR ¼ 0.19, 95% CI ¼ 0.0-0.9) and direct discharge to chronic care were associated with 50 or more specialist visits. Only rurality predicted two or more visits to the ED. Conclusions: Individuals with traumatic SCI show significant physician utilization, especially among their FPs and physiatrists. Although the factors predicting higher physician and specialist utilization may reflect individuals with the most severe impairment, comorbid conditions or lack of social support, the model for higher ED visits may point to limited accessibility to/availability of primary care services for SCI patients in rural regions.

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Reasons for rehospitalization in patients with spinal cord injury: 5 years' experience

Cited by 49 publications

References 17 publications

Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study

Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study

Health system factors associated with rehospitalizations after traumatic spinal cord injury: a population-based study

Physician utilization among adults with traumatic spinal cord injury in Ontario: a population-based study

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