Abstract
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 (2003–2006) 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=1002) were greater than TSCI (n=560). NTSCIs were older (mean=61.6, s.d.=15.8) with more co-morbidities, paraplegic (39.5%) and female (P<0.001). 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=24) and 29.7 (median=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=1.5; 95% CI=1.2–1.9), urban living (OR=1.59; 95% CI=1.12–2.22) and lowest quartile (18–88) discharge FIM (OR=1.8; 95% CI=1.4–2.3). Charlson score of 3 or more (OR=2.1; 95% CI=1.3–3.2), urban living (OR=1.92; 95% CI=1.3–2.86) and lowest quartile discharge FIM (OR=1.5; 95% CI=1.2–2.0) were associated with 20 or more specialist visits. Factors for high ED use were: rurality (OR=1.5; 95% CI=1.1–2.1), low income (OR=1.4; 95% CI=1.1–1.9) and low (18–88) discharge FIM (OR=1.7; 95% CI=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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Acknowledgements
This research was supported by a grant from the Ontario Neurotrauma Foundation (ONF). Dr Jaglal is the Toronto Rehabilitation Institute (TRI) Chair at the University of Toronto in Health Services Research. Ms Guilcher's doctorate is supported by the Women's College Research Institute, ONF, TRI and Ontario Training Collaborative Program in Health Services and Policy Research. We acknowledge the support of TRI which receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-Term Care in Ontario. The views expressed do not necessarily reflect those of the Ministry. Many thanks are expressed to Xuesong Wang at ICES who conducted statistical programming for this work.
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Guilcher, S., Munce, S., Couris, C. et al. Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study. Spinal Cord 48, 45–50 (2010). https://doi.org/10.1038/sc.2009.78
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DOI: https://doi.org/10.1038/sc.2009.78
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