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Effectiveness of a Wellness Program for Individuals With Spina Bifida and Spinal Cord Injury Within an Integrated Delivery System

      Abstract

      Objective

      To determine whether an evidence-based wellness program for individuals with spina bifida and spinal cord injury would improve health outcomes and patient experience of care, result in a positive return on investment (ROI), and provide evidence for scalability.

      Design

      Nonrandomized, noncontrolled cohort study; 2 years of enrollment.

      Setting

      Academic hospital-based outpatient physiatry clinic partnered with an insurance division within an integrated health care delivery and financing system.

      Participants

      Individuals (N=69) with spina bifida and spinal cord injury were consented; 4 were excluded (5.7%), and the remaining 65 (94.2%) participated in the intervention.

      Interventions

      Evidence-based wellness program consisting of care coordination from a mobile nurse, patient education, and patient incentives.

      Main Outcome Measures

      Validated measures of function, mood, quality of life, and perception of care delivery; knowledge of preventable conditions; self-rating of health; and utilization and cost.

      Results

      Improvements in all main outcome measures were seen after 2 years of enrollment. Although cost in year 1 of enrollment increased because of hospitalizations and the overall ROI was negative, a small positive ROI was seen in year 2 of enrollment.

      Conclusions

      Participation in an evidence-based wellness program was associated with improved health and experience of care. Scaling the program to larger numbers may result in an overall positive ROI.

      Keywords

      List of abbreviations:

      BDI-II (Beck Depression Inventory-II), CHART-SF (Craig Handicap Assessment and Reporting Technique-Short Form), ED (emergency department), PACIC (Patient Assessment of Chronic Illness Care), ROI (return on investment), SB (spina bifida), SCI (spinal cord injury), UTI (urinary tract infection), WHOQOL-BREF (World Health Organization Quality of Life-Brief Form)
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