Abstract
Objective
The purpose of this study was to (1) categorize individuals into high, medium, and
low utilizers of health care services over a 10-year period after the onset of spinal
cord injury (SCI) and (2) identify the pattern of causes of hospitalizations and the
characteristics associated with high utilization.
Design
Retrospective analysis of self-report assessment linked to administrative data.
Setting
Data were collected from participants living in and utilizing hospitals in the state
of South Carolina.
Participants
Adult participants with traumatic SCI were identified through a state SCI Surveillance
System Registry, a population-based system capturing all incident cases treated in
nonfederal facilities. Among 963 participants who completed self-report assessments,
we matched those with a minimum of 10 years of administrative records for a final
sample of 303 participants (N=303).
Interventions
Not applicable.
Main Outcome Measures
Costs related to health care utilization for emergency department visits and hospitalizations,
as measured operationally by hospital charges at full and established rates; causes
of hospitalizations
Results
Over two-thirds of the total $49.4 million in charges for hospitalization over the
10-year timeframe (69%) occurred among 16.5% of the cohort (high utilizers), whereas
those in the low utilizer group comprised 53% of the cohort with only 3.5% of the
charges. The primary diagnoses were septicemia (50%), other urinary tract disorder
(48%), mechanical complication of device, implant, or graft (48%), and chronic ulcer
of skin (40%). Primary diagnoses were frequently accompanied by secondary diagnoses,
indicating the co-occurrence of multiple secondary health conditions. High utilizers
were more likely to be male, minority, have a severe SCI, have reported frequent pressure
ulcers and have income of less than $35,000 per year.
Conclusions
The high cost of chronic health care utilization over a 10-year timeframe was concentrated
in a relatively small portion of the SCI population who have survived more than a
decade after SCI onset.
Keywords
List of abbreviations:
BRFSS (Behavioral Risk Factor Surveillance System), CDC (Centers for Disease Control and Prevention), ED (emergency department), HCU (health care utilization), ICD-9-CM (International Classification of Diseases-9th Revision-Clinical Modification), SCI (spinal cord injury), SHC (secondary health condition)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 23, 2018
Footnotes
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; grant no. 90IF0119 and 90RT5003) and the South Carolina Spinal Cord Injury Research Fund (SCSCIRF; grant no. SCIRF 09-001). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, HHS, or SCSCIRF, and you should not assume endorsement by the Federal Government or the state of South Carolina.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
