Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study.
METHODS
Retrospective cohort design.


OBJECTIVE
To compare socio-demographic, impairment characteristics and utilization (physician and emergency department (ED) visits) for non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury 1 year post inpatient rehabilitation.


METHODS
Ontario, Canada.


METHODS
Inpatient stays (2003-2006) were identified from the National Rehabilitation Registry System. Exclusions were: in-hospital mortality; discharge after 31 March 2006; death within 1 year after discharge. Multivariate logistic regression analyses were used to determine factors predicting high utilization.


RESULTS
NTSCI cases (n=1002) were greater than TSCI (n=560). NTSCIs were older (mean=61.6, s.d.=15.8) with more co-morbidities, paraplegic (39.5%) and female (P<0.001). NTSCI had higher FIM admission and discharge scores but lower change scores. Mean number of physician visits for NTSCI and TSCI were 31.2 (median=24) and 29.7 (median=22), with no significant differences in mean specialist visits (NTSCI 16.5: TSCI 17.0). Factors predicting 30 or more physician visits included age 60 years or above (OR=1.5; 95% CI=1.2-1.9), urban living (OR=1.59; 95% CI=1.12-2.22) and lowest quartile (18-88) discharge FIM (OR=1.8; 95% CI=1.4-2.3). Charlson score of 3 or more (OR=2.1; 95% CI=1.3-3.2), urban living (OR=1.92; 95% CI=1.3-2.86) and lowest quartile discharge FIM (OR=1.5; 95% CI=1.2-2.0) were associated with 20 or more specialist visits. Factors for high ED use were: rurality (OR=1.5; 95% CI=1.1-2.1), low income (OR=1.4; 95% CI=1.1-1.9) and low (18-88) discharge FIM (OR=1.7; 95% CI=1.3-2.2).


CONCLUSIONS
Both demonstrated significant health care utilization requiring attention to health care needs; particularly for those living in rural settings, with low income and/or low functional ability.
Guilcher
S J T
SJ
Department of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Munce
S E P
SE
Couris
C M
CM
Fung
K
K
Craven
B C
BC
Verrier
M
M
Jaglal
S B
SB
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018672:Community Health Planning; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009864:Ontario / Q000453:epidemiology; D010264:Paraplegia / Q000534:rehabilitation; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000145:classification / Q000453:epidemiology* / Q000534:rehabilitation*; D018709:Statistics, Nonparametric