analysis of registry healthcare utilization data for spinal cord injury patients over ten years...

Analysis of Registry Healthcare Utilization Data for Spinal Cord Injury Patients Over Ten Years

Simon Driver, PhDMonica Bennett, PhD

Rita Hamilton, DO

Seema Sikka, MDAnn Marie Warren, PhD

Megan Reynolds, MS Laura Petrey, MD

Disclosures• AMW, MR, and MB are the recipients of a research grant

from the Stanley Seeger Fund of the Baylor Health Care System Foundation.

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Dallas, Texas

Spinal Cord Injury (SCI)• Use a disproportionate amount of health services and dollars 1

• More likely to have problems accessing health services1

• High risk for:– deteriorating health – onset of secondary conditions– loss of functional independence1

• Live longer, face new challenges associated with longevity1

• Average LOS in post-acute rehab declined from 115 days in 1973 to 36 days in 20052

1 Special Interest Group on SCI Model System Innovation; 2 www.spinalcord.uab.edu

Previous Research• Rates of rehospitalization range 19-57% in the first year

post-SCI1

– Largely due to secondary conditions (e.g., pneumonia, pressure sores, UTIs)

• Lower Motor FIMs at rehab discharge associated with increased readmissions3

• However, this research is limited to:– Single institutions– Model Systems– International data

3Brannon R, DeJong G, Batavia A, Meehan, M. Health insurance coverage for persons with disabilities: Analysis of public programs and private plans. 1990

ObjectivesTo identify:– Incidence – Prevalence– Characteristics (e.g., reasons, cost)

of healthcare utilization among patients originally admitted to a Level I trauma center with SCI over the course of a decade using a regional hospital registry.

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SettingLevel I Trauma Center in Dallas, TX– Admits ~2,500 patients annually

Dallas-Ft. Worth Hospital Council– 75 member institutions (>140 hospitals) – 15 years of collected data– 10 million patients– 40 million hospital visits

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Over 15,000 square miles

BUMC

Participants

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649 patients

597 final total

52 excluded

Admitted with acute traumatic SCI between

Jan 2003-June 2014

Expired during initial

hospitalization

≈57 patients/year

Main Outcome Measures

• Inpatient and outpatient utilization characteristics– Demographics– Insurance– Hospital charges– Diagnosis-related groups (DRGs)– Specialization

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Results

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Demographics N=597

Age 45.9±18.8

Male Gender 443 (74%)

Race White 343 (57%)

Black 147 (25%)

Asian 6 (1%)

Other 101 (17%)

Hispanic Ethnicity 89 (15%)

Insurance

Private 245 (41%)

Public 122 (20%)

Uninsured 230 (39%) =59%Compared to 50.4% in 2014 MS data

N=597 SCI patients

75% (n=447) additional utilization

1850 visits

70% outpatient (1298 visits)

30% inpatient(552)

25% (n=150)none documented

Results

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January 2003 – June 2014

Median number of additional visits = 3 Maximum = 22

Results: Inpatient Utilization Post- SCI

Rehabilitation37%

Spinal Disorders and Injuries17%

Septicemia10%

Cervial Spinal Fusion and other procedures

8%

Kidney and UTIs7%

Other disorders of nervous system

5%

Pulmonary edema and respi-ratory failure

5%

Infectious diseases w/ OR pro-cedure

4%

Spinal Procedures4%

Skin grafts3%

APR-DRG

≈30% preventable

n=

• 47% were emergency, urgent, or trauma-related• LOS– Mean = 10 days– Range = 4-28 days

• Total charges– Mean = $37,753 – Range = $19,981 - $67,344

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Results: Inpatient Utilization Post- SCI

Results: Outpatient Utilization Post-SCI

Phys Med & Rehab24%

Emergency17%

Specialist10%

Neuro surgery7%

Internal Med4%

Urology2%

Orthopedic Surgery2%

Pain Medicine2%

Family Medicine1%

Orthopedic Spine Surgery1%

General Acute Care Hospital1%

Diagnostic Radiology1%

Other/Not Listed29%

Specialization

n=

• 21.3% were medical emergency, urgent, or trauma-related

• Total charges– Mean = $11,487– Range = $488 - $3,605

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Results: Outpatient Utilization Post- SCI

Conclusions• Individuals with SCI experience healthcare utilization that may be largely

preventable• Not only costly to the healthcare system but to the individuals with SCI

– $

• This analysis is unique in that it objectively reports healthcare utilization across different healthcare systems – Not limited to a single institution– Multiple hospitals per patient

• Increasing understanding of healthcare utilization post acute SCI is critical– Development of preventative strategies– Continuity of care

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Summary of Citations & Level of Evidence1.Special Interest Group on SCI Model System Innovation (2010). Toward a Model System of Post-rehabilitative Health Care for Individuals with SCI. Washington, DC. National Rehabilitation Hospital: National Capital Spinal Cord Injury Model System (NCSCIMS). http://www.ncscims.org/SCIModelSystemInnovationReport.pdf LOE 12.National Spinal Cord Injury Statistical Center (NSCISC). Facts and Figures at a Glance. Updated 2015. www.spinalcord.uab.edu LOE 13.Brannon R, DeJong G, Batavia A, Meehan, M. Health insurance coverage for persons with disabilities: Analysis of public programs and private plans. 1990 LOE 1