title: Health care utilization in persons with traumatic spinal cord injury: the importance of multimorbidity and the impact on patient outcomes.
abstract: BACKGROUND
  Persons with spinal cord injury (SCI) living in the community have high health care utilization (HCU). To date, the interrelationships among multiple secondary health conditions (multimorbidity due to comorbidities and complications) that drive HCU and their impact on patient outcomes are unknown.
  
  
  OBJECTIVE
  To determine the association among multimorbidity, HCU, health status, and quality of life.
  
  
  METHODS
  Community-dwelling persons with traumatic SCI participated in an online/phone SCI Community Survey. Participants were grouped using the 7-item HCU questionnaire (group 1 did not receive needed care and/or rehospitalized; group 2 received needed care but rehospitalized; group 3 received needed care and not rehospitalized). Personal, injury, and environmental factors; multimorbidity (presence/absence of 30 comorbidities/ complications); health status (Short Form-12); and quality of life measures (Life Satisfaction-11 first question and single-item quality of life measure) were collected. Associations among these variables were assessed using multivariate analysis.
  
  
  RESULTS
  The 1,137 survey participants were divided into 3 groups: group 1 (n = 292), group 2 (n = 194), and group 3 (n = 650). Group 1 had the greatest number of secondary health conditions (15.14 ± 3.86) followed by group 2 (13.60 ± 4.00) and group 3 (12.00 ± 4.16) (P < .05). Multimorbidity and HCU were significant risk factors for having a lower SF-12 Mental (P < .001) and Physical Component Score (P < .001). They in turn were associated with participants reporting a lower quality of life (P < .001, for both questions).
  
  
  CONCLUSIONS
  Multimorbidity and HCU are interrelated and associated with lower health status, which in turn is associated with lower quality of life. Future work will include the development of a screening tool to identify persons with SCI at risk of inappropriate HCU (eg, rehospitalization, not able to access care), which should lead to better patient outcomes and cost savings.
authors.affiliation: University of British Columbia , Vancouver, British Columbia , Canada ; Rick Hansen Institute , Vancouver, British Columbia , Canada.
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Noonan
authors.affiliation: University of British Columbia , Vancouver, British Columbia , Canada ; Rick Hansen Institute , Vancouver, British Columbia , Canada.
authors.forename: Nader
authors.initials: N
authors.lastname: Fallah
authors.affiliation: University of British Columbia , Vancouver, British Columbia , Canada ; Rick Hansen Institute , Vancouver, British Columbia , Canada.
authors.forename: So Eyun
authors.initials: SE
authors.lastname: Park
authors.affiliation: Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) and Université Laval , Quebec City , Canada.
authors.forename: Frédéric S
authors.initials: FS
authors.lastname: Dumont
authors.affiliation: Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) and Université Laval , Quebec City , Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Leblond
authors.affiliation: Vancouver General Hospital , Vancouver, British Columbia , Canada.
authors.forename: John
authors.initials: J
authors.lastname: Cobb
authors.affiliation: Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) and Université Laval , Quebec City , Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Noreau
keywords: access to care; health care utilization; health status; multimorbidity; rehospitalization; secondary health conditions; spinal cord injury