Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study

Abstract

Study Design: Retrospective cohort design. Objectives: 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. Setting: 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). Conclusion: 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.