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Concentration of Costs Among High Utilizers of Health Care Services Over the First 10 Years After Spinal Cord Injury Rehabilitation: A Population-based Study

Published:November 23, 2018DOI:https://doi.org/10.1016/j.apmr.2018.10.020

      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)
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