Highlights
- •Adults with TSCI compared with adults without TSCI had substantially higher risk for potentially preventable hospitalizations (or ambulatory care sensitive conditions).
- •Adults with TSCI compared with adults without TSCI were particularly at higher risk of hospitalization for urinary tract infection, pneumonia, and heart failure.
- •Annual wellness visit was associated with reducing the risk of potentially preventable hospitalizations for adults with TSCI compared with adults with TSCI who did not have an annual wellness visit.
Abstract
Objective
To examine the risk of potentially preventable hospitalizations (PPHs) for adults
(18 years or older) with traumatic spinal cord injury (TSCI) to identify the most
common types of preventable hospitalizations and their associative risk factors.
Design
Cohort study.
Setting
Using 2007-2017 U.S. claims data from the Optum Clinformatics Data Mart, we identified
adults (18 years or older) with diagnosis of TSCI (n=5380). Adults without TSCI diagnosis
were included as controls (n=1,074,729). Using age and sex, we matched individuals
with and without TSCI (n=5173) with propensity scores to address potential selection
bias. Generalized linear regression was applied to examine the risk of TSCI on PPHs.
Models were adjusted for age; sex; race and ethnicity; Elixhauser comorbidity count;
any cardiometabolic, psychological, and musculoskeletal chronic conditions; U.S. Census
Division; socioeconomic variables; and use of certain preventative care services.
Adjusted odds ratios were compared within a 4-year follow-up period.
Participants
Adults with and without TSCI (N=5,173).
Intervention
Not applicable.
Main Outcomes Measures
Any PPH and specific PPHs
Results
Adults with TSCI had higher risk for any PPH (odds ratio [OR], 1.67; 95% CI,1.20-2.32),
as well as PPHs because of urinary tract infection (UTI) (OR, 3.78; 95% CI, 2.47-5.79),
hypertension (OR, 3.77; 95% CI, 1.54-9.21), diabetes long-term complications (OR,
2.54; 95% CI, 1.34-4.80), and pneumonia (OR, 1.71; 95% CI. 1.21-2.41). Annual wellness
visit was associated with reduced PPH risk compared with cases and controls without
annual wellness visit (OR, 0.57; 95% CI, 0.46-0.71) and among people with TSCI (OR,
0.69; 95% CI, 0.55-0.86) compared with cases without annual wellness visit.
Conclusions
Adults with TSCI are at a heightened risk for PPH. They are also more susceptible
to certain PPHs such as UTIs, pneumonia, and heart failure. Encouraging the use of
preventative or health-promoting services, especially for respiratory and urinary
outcomes, may reduce PPHs among adults with TSCI.
Keywords
List of abbreviations:
COPD (chronic obstructive pulmonary disease), OT (occupational therapy), OR (odds ratio), PPH (potentially preventable hospitalization), PQI (prevention quality indicator), PT (physical therapy), TSCI (traumatic 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
Publication history
Published online: March 21, 2022
Accepted:
December 3,
2021
Received in revised form:
November 11,
2021
Received:
August 20,
2021
Footnotes
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR #90RTHF0001-01-00).
Disclosures: none
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
