Effectiveness of a Wellness Program for Individuals With Spina Bifida and Spinal Cord Injury Within an Integrated Delivery System.
To determine whether an evidence-based wellness program for individuals with spina bifida and spinal cord injury would improve health outcomes and patient experience of care, result in a positive return on investment (ROI), and provide evidence for scalability.



Nonrandomized, noncontrolled cohort study; 2 years of enrollment.



Academic hospital-based outpatient physiatry clinic partnered with an insurance division within an integrated health care delivery and financing system.



Individuals (N=69) with spina bifida and spinal cord injury were consented; 4 were excluded (5.7%), and the remaining 65 (94.2%) participated in the intervention.



Evidence-based wellness program consisting of care coordination from a mobile nurse, patient education, and patient incentives.



Validated measures of function, mood, quality of life, and perception of care delivery; knowledge of preventable conditions; self-rating of health; and utilization and cost.



Improvements in all main outcome measures were seen after 2 years of enrollment. Although cost in year 1 of enrollment increased because of hospitalizations and the overall ROI was negative, a small positive ROI was seen in year 2 of enrollment.



Participation in an evidence-based wellness program was associated with improved health and experience of care. Scaling the program to larger numbers may result in an overall positive ROI.
Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: dicianno@pitt.edu.
Brad E
BE
Dicianno
University of Pittsburgh Medical Center for High-Value Health Care, University of Pittsburgh Medical Center Insurance Services Division, Pittsburgh, PA.
John
J
Lovelace
University of Pittsburgh Medical Center for High-Value Health Care, University of Pittsburgh Medical Center Insurance Services Division, Pittsburgh, PA; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Pamela
P
Peele
University of Pittsburgh Medical Center for High-Value Health Care, University of Pittsburgh Medical Center Insurance Services Division, Pittsburgh, PA.
Christopher
C
Fassinger
University of Pittsburgh Medical Center for High-Value Health Care, University of Pittsburgh Medical Center Insurance Services Division, Pittsburgh, PA.
Patricia
P
Houck
Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Alexandra
A
Bursic
Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Michael L
ML
Boninger
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017060:Patient Satisfaction; D010465:Perception; D011788:Quality of Life; D015203:Reproducibility of Results; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D016135:Spinal Dysraphism / Q000534:rehabilitation*; D055815:Young Adult
Emergency service, hospital; Health promotion; Hospitalization; Pressure ulcer; Preventive medicine; Rehabilitation; Sepsis; Spinal cord injuries; Spinal dysraphism; Urinary tract infections