Utilization of health services following spinal cord injury: a 6-year follow-up study

Abstract

Study design: Cohort study with 6-years follow-up. Objective: To describe the utilization of health services by persons with spinal cord injury (SCI) and compare it with that of the general population. Setting: Alberta, Canada. Methods: All persons who sustained an SCI in Alberta between April 1992 and March 1994 were followed from date of injury to 6 years postinjury. Cases were matched (1:5) with controls randomly selected from the general population and matched for age, gender, and region of residence. Administrative data from centralized health care databases were compiled to provide a complete picture of health care use, including hospitalizations, physician contacts, long-term care admissions, home care services, and the occurrence of secondary complications. Results: In all, 233 individuals with SCI and 1165 matched controls were followed for 6 years. Compared with the control group, persons with SCI were rehospitalized 2.6 times more often, spent 3.3 more days in hospital, were 2.7 times more likely to have a physician contact, and required 30 times more hours of home care services. Of those with SCI, 47.6% were treated for a urinary tract infection, 33.8% for pneumonia, 27.5% for depression, and 19.7% for decubitus ulcer. Conclusion: SCI places a heavy burden on the health care system. Persons with SCI have greater rates of contact with the health system compared with the general population. Secondary complications continue to affect persons with SCI long after the acute trauma.

Secondary health conditions in individuals aging with SCI: Terminology, concepts and analytic approaches

“…This model hypothesizes that both disability factors, such as the presence of impairment or significant restrictions in activity or participation, as well as age-related factors (such as chronological age, age at disability onset, disability inception era and duration of disability), can have direct effects on the development and trajectory of SHCs. The model also hypothesizes that disability and age-related variables can influence the effects of 38,39 Chronic pain 40 Constipation 41 Contractures 27 Deep vein thrombosis/pulmonary embolism 42 Depression 42 Fractures 27 Heterotopic ossification 43 Imobilization hypercalcemia 44 Insomnia/sleep difficulties 37 Kidney stones 18,27 Neurogenic bladder 45 Neurogenic bowel 46 Non-urinary tract infections 27 Obesity 29 Osteoporosis/Bone density loss 15,17,29 Pressure sores 18,41 Restrictive lung disease 47 Septicemia 41 Sexual dysfunction 48,49 Sleep apnea 50 …”

Perceptions of issues associated with the maintenance and improvement of long-term health in people with SCI

“…2 They are also at risk for secondary conditions such as bladder infections and pressure sores, conditions that will not affect their nondisabled peers and result in increased utilization of the health care system by people with SCI. 3 Management of secondary conditions in people with SCI is an ongoing process that depends on consistency, vigilance, up to date information, and life long learning skills. 4 Patient education during the rehabilitation phase of SCI (ie the initial rehabilitative stay following acute management) is a component of preventative rehabilitation and is designed to educate patients about secondary conditions and how to prevent them in the long term.…”

On the need of validating inpatient registers

“…[10][11][12][13] Others calculate the LOS from the day of injury, 14 include individuals admitted for their initial episode 15 or use date of the index hospitalization as the date of the SCI. 16 All these studies lack further analysis regarding possible divergence between the onset of traumatic SCI and admission date. Putzke et al 17 and Fine et al, 18 on the other hand, include individuals admitted on the first day of injury.…”

“…19 These studies all have different inclusion criteria, terms of description and grouping when it comes to etiology, age, injury year, level and extent of injury and type of care. [10][11][12][13][15][16][17]20 This impedes comparison. No discussion has been found in any of the published studies about how realistic it is to have very few or many inpatient days registered.…”

“…Some researchers do not examine the acute LOS, for example. 15,16 Several studies [11][12][13]20 spring from persons discharged from the Model System with an enrol system of patients being admitted within 60 days of injury. In some studies, 86-93% of all patients were admitted to the investigated clinics within 21 days of injury.…”