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Preventative Services Use and Risk Reduction for Potentially Preventative Hospitalizations Among People With Traumatic Spinal Cord Injury

  • Elham Mahmoudi
    Correspondence
    Corresponding author Elham Mahmoudi, PhD, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Bldg 14, Room G234, Ann Arbor, MI 48109.
    Affiliations
    Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Paul Lin
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Samantha Ratakonda
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Anam Khan
    Affiliations
    School of Public Health, University of Michigan, Ann Arbor, MI

    Institute for Social Research, University of Michigan, Ann Arbor, MI
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  • Neil Kamdar
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Mark D. Peterson
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Published:March 21, 2022DOI:https://doi.org/10.1016/j.apmr.2021.12.004

      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)
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