Abstract
Objective
To determine rates of rehospitalization among discharged rehabilitation patients with
traumatic spinal cord injury (SCI) in the first 12 months postinjury, and to identify
factors associated with rehospitalization.
Design
Prospective observational cohort study.
Setting
Six geographically dispersed rehabilitation centers in the U.S.
Participants
Consecutively enrolled individuals with new traumatic SCI (N=951), who were discharged
from participating rehabilitation centers and participated in a 1-year follow-up survey.
Interventions
Not applicable.
Main Outcome Measures
Occurrence of postrehabilitation rehospitalization within 1 year of injury, length
of rehospitalization stays, and causes of rehospitalizations.
Results
More than one third (36.2%) of participants were rehospitalized at least once in the
12-month follow-up period; 12.5% were rehospitalized at least twice. The average number
of rehospitalizations among those rehospitalized at least once was 1.37 times, with
an average length of stay (LOS) of 15.5 days across all rehospitalization episodes.
The 3 most common health conditions associated with rehospitalization were those related
to the genitourinary system (eg, urinary tract infection), respiratory system (eg,
pneumonia), and skin and subcutaneous tissue (eg, pressure ulcer). Being a woman (95%
confidence interval [CI], 1.034–2.279), having Medicaid as the main payer (95% CI,
1.303–2.936), and more severe case mix were associated with increased odds of rehospitalization.
Those who had more intensive physical therapy (95% CI, .960–.981) had lower odds of
rehospitalization. Some center-to-center variation in rehospitalization rates remained
unexplained after case mix and practice differences were considered. The 6 SCI rehabilitation
centers varied nearly 2-fold in rates at which their former SCI patients were rehospitalized—from
27.8% to 50%. Center-to-center variation diminished when patient case mix was considered.
Conclusions
Compared with earlier studies, rehospitalization rates among individuals with SCI
in the first postinjury year remain high and vary by level and completeness of injury.
Rehospitalization risk was associated with younger age, being a woman, unemployment
and retirement, and Medicaid coverage. Those who had more intensive physical therapy
had lower odds of rehospitalization. Future studies should examine center-to-center
variations in rehospitalization rates and availability of patient education and community
resources.
Keywords
List of abbreviations:
AIS (American Spinal Injury Association Impairment Scale), CMG (case-mix group), CMI (case-mix index), CSI (Comprehensive Severity Index), IRF (inpatient rehabilitation facility), LOS (length of stay), OR (odds ratio), PHQ-9 (Personal Health Questionnaire-9), SCI (spinal cord injury), UTI (urinary tract infection)To read this article in full you will need to make a payment
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Article info
Footnotes
Supported in part by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education (grant nos. H133A060103, H133N060005, H133N060028, H133N060009, H133N060014, H133N060027, H133N060009).
The opinions contained in this publication are those of the authors and do not necessarily reflect those of the U.S. Department of Education.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
