Analysis of Registry Healthcare Utilization Data for Spinal Cord Injury Patients Over Ten Years Simon Driver, PhD Monica Bennett, PhD Rita Hamilton, DO Seema Sikka, MD Ann 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. #aapmr2015 Dallas, Texas

Spinal Cord Injury (SCI) Use a disproportionate amount of health services and dollars 1 More likely to have problems accessing health services 1 High risk for: – deteriorating health – onset of secondary conditions – loss of functional independence 1 Live longer, face new challenges associated with longevity 1 Average LOS in post-acute rehab declined from 115 days in 1973 to 36 days in Special Interest Group on SCI Model System Innovation; 2 #aapmr2015

Previous Research Rates of rehospitalization range 19-57% in the first year post-SCI 1 – Largely due to secondary conditions (e.g., pneumonia, pressure sores, UTIs) Lower Motor FIMs at rehab discharge associated with increased readmissions 3 However, this research is limited to: – Single institutions – Model Systems (N=13) – International data (universal healthcare) – 1 year post-SCI 3 Brannon R, DeJong G, Batavia A, Meehan, M. Health insurance coverage for persons with disabilities: Analysis of public programs and private plans #aapmr2015

Objectives To 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.

Setting Level I Trauma Center in Dallas, TX – Admits ~2,500 patients annually; Jan 2003-June 2014 Dallas-Ft. Worth Hospital Council – 75 member institutions (>140 hospitals) – 15 years of collected data – 10 million patients – 40 million hospital visits

Over 15,000 square miles BUMC

Participants 649 patients 597 final total 52 excluded Admitted with acute traumatic SCI between Jan 2003-June 2014 Expired during initial hospitalization ≈57 patients/year

Results 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 January 2003 – June 2014 Median number of additional visits = 3 Maximum = 22

Results: Inpatient Utilization Post-SCI ≈30% preventable

47% were emergency, urgent, or trauma-related LOS – Median = 10 days – IQR Range = 4-28 days Total charges – Mean = $54,203 – Range = $3,266 - $1,304,473 Results: Inpatient Utilization Post- SCI

Results: Outpatient Utilization Post-SCI n=

21.3% were medical emergency, urgent, or trauma-related Total charges – Mean = $3,182 – Maximum = $79,852 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 #aapmr2015

Summary of Citations & Level of Evidence 1.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). LOE 1http:// 2.National Spinal Cord Injury Statistical Center (NSCISC). Facts and Figures at a Glance. Updated LOE 1www.spinalcord.uab.edu 3.Brannon R, DeJong G, Batavia A, Meehan, M. Health insurance coverage for persons with disabilities: Analysis of public programs and private plans LOE 1

Future Directions Pull from multiple trauma centers Identify interventions for preventable conditions that were identified with high readmission rates Extend analyses to other diagnoses groups #aapmr2015