RESUMEN
Importance: Spinal cord injury (SCI) causes drastic changes to an individual's physical health that may be associated with the ability to work. Objective: To estimate the association of SCI with individual earnings and employment status using national administrative health databases linked to income tax data. Design, Setting, and Participants: This was a retrospective, national, population-based cohort study of adults who were hospitalized with cervical SCI in Canada between January 2005 and December 2017. All acute care hospitalizations for SCI of adults ages 18 to 64 years were included. A comparison group was constructed by sampling from individuals in the injured cohort. Fiscal information from their preinjury years was used for comparison. The injured cohort was matched with the comparison group based on age, sex, marital status, province of residence, self-employment status, earnings, and employment status in the year prior to injury. Data were analyzed from August 2022 to January 2023. Main outcomes and Measures: The first outcome was the change in individual annual earnings up to 5 years after injury. The change in mean yearly earnings was assessed using a linear mixed-effects differences-in-differences regression. Income values are reported in 2022 Canadian dollars (CAD $1.00 = US $0.73). The second outcome was the change in employment status up to 5 years after injury. A multivariable probit regression model was used to compare proportions of individuals employed among those who had experienced SCI and the paired comparison group of participants. Results: A total of 1630 patients with SCI (mean [SD] age, 47 [13] years; 1304 male [80.0%]) were matched to patients in a preinjury comparison group (resampled from the same 1630 patients in the SCI group). The mean (SD) of preinjury wage earnings was CAD $46â¯000 ($48â¯252). The annual decline in individual earnings was CAD $20â¯275 (95% CI, -$24â¯455 to -$16â¯095) in the first year after injury and CAD $20â¯348 (95% CI, -$24â¯710 to -$15â¯985) in the fifth year after injury. At 5 years after injury, 52% of individuals who had an injury were working compared with 79% individuals in the preinjury comparison group. SCI survivors had a decrease in employment of 17.1 percentage points (95% CI, 14.5 to 19.7 percentage points) in the first year after injury and 17.8 percentage points (14.5 to 21.1 percentage points) in the fifth year after injury. Conclusions and Relevance: In this study, SCI was associated with a decline in earnings and employment up to 5 years after injury for adults aged 18 to 64 years in Canada.
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Empleo , Renta , Traumatismos de la Médula Espinal , Humanos , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/epidemiología , Masculino , Femenino , Adulto , Empleo/estadística & datos numéricos , Persona de Mediana Edad , Renta/estadística & datos numéricos , Estudios Retrospectivos , Canadá/epidemiología , Adulto Joven , Adolescente , Médula Cervical/lesionesRESUMEN
OBJECTIVE: To estimate and compare unmet health care needs of persons with spinal cord injury (SCI) across countries, the causes of these shortfalls, and the role of income. DATA SOURCES: We analyzed cross-sectional data of 20 countries from the International Spinal Cord Injury (InSCI) survey, a compendium of comparable data on the living situation of persons with SCI. Data included information on high-, middle-, and low-income countries. The survey comprises information on 12,095 participants. STUDY DESIGN: We used logit regressions to estimate the probability of unmet health care needs of persons with SCI and its causes. We adjusted the results by the individuals' characteristics and countries' fixed effects. We disaggregated the results by income decile of individuals in each country. DATA COLLECTION/EXTRACTION METHODS: The inclusion criteria for the InSCI survey were adults aged 18 years and older with SCI living in the community, who were able to respond to the survey and who provided informed consent. PRINCIPAL FINDINGS: Unmet health care needs are significant for people with long-term conditions like SCI, where people in low-income groups tend to be more affected. Among the barriers to meeting health care needs, the foremost is health care cost (in 11 of the 20 countries), followed by transportation and service availability. Persons with SCI in Morocco reported the highest probability of unmet health care needs in the sample, 0.54 (CI: 047-0.59), followed well behind by South Africa, 0.27 (CI: 0.20-0.33), and Brazil, 0.26 (CI: 0.20-0.33). In contrast, persons with SCI in Spain, 0.06 (CI: 0.04-0.08), reported the lowest probability of unmet health care needs, closely followed by Norway, 0.07 (CI: 0.05-0.09), Thailand, 0.08 (CI: 0.05-0.11), France, 0.08 (CI: 0.06-0.11), and Switzerland, 0.09 (CI: 0.07-0.10). CONCLUSIONS: SCI is a long-term, irreversible health condition characterized by physical impairment and a series of chronic illness. This makes SCI a high-need, high-cost group that faces significant unmet health care needs, which are mainly explained by the costs of health services, transportation, and services availability. This situation is prevalent in low-, middle-, and high-income countries, where persons in lower income groups are disproportionately affected. To improve the situation, a combination of measures from the health and social systems are required.
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Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud , Pobreza , Traumatismos de la Médula Espinal/economía , Adulto , Estudios Transversales , Europa (Continente) , Femenino , Instituciones de Salud , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , TransportesRESUMEN
PURPOSE: Neurogenic lower urinary tract dysfunction is a significant source of morbidity for individuals with spinal cord injury and is managed with a range of treatment options that differ in efficacy, tolerability and cost. The effect of insurance coverage on bladder management, symptoms and quality of life is not known. We hypothesized that private insurance is associated with fewer bladder symptoms and better quality of life. MATERIALS AND METHODS: This is a cross-sectional, retrospective analysis of 1,226 surveys collected as part of the prospective Neurogenic Bladder Research Group SCI Registry. We included patients with complete insurance information, which was classified as private or public insurance. The relationship between insurance and bladder management, bladder symptoms and quality of life was modeled using multinomial logistic regression analysis. Spinal cord injury quality of life was measured by the Neurogenic Bladder Symptom Score. RESULTS: We identified 654 privately insured and 572 publicly insured individuals. The demographics of these groups differed by race, education, prevalence of chronic pain and bladder management. Publicly insured patients were more likely to be treated with indwelling catheters or spontaneous voiding and less likely to take bladder medication compared to those with private insurance. On multivariate analysis insurance type was not associated with differences in bladder symptoms (total Neurogenic Bladder Symptom Score) or in urinary quality of life. CONCLUSIONS: There is an association between insurance coverage and the type of bladder management used following spinal cord injury, as publicly insured patients are more likely to be treated with indwelling catheters. However, insurance status, controlling for bladder management, did not impact bladder symptoms or quality of life.
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Disparidades en Atención de Salud/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Traumatismos de la Médula Espinal/complicaciones , Vejiga Urinaria Neurogénica/terapia , Adulto , Catéteres de Permanencia/economía , Catéteres de Permanencia/estadística & datos numéricos , Estudios Transversales , Femenino , Disparidades en Atención de Salud/economía , Humanos , Cobertura del Seguro/economía , Seguro de Salud/economía , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente/economía , Estudios Prospectivos , Calidad de Vida , Estudios Retrospectivos , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/terapia , Resultado del Tratamiento , Vejiga Urinaria/inervación , Vejiga Urinaria/fisiopatología , Vejiga Urinaria Neurogénica/diagnóstico , Vejiga Urinaria Neurogénica/economía , Vejiga Urinaria Neurogénica/etiología , Cateterismo Urinario/economía , Cateterismo Urinario/estadística & datos numéricosRESUMEN
OBJECTIVES: To present recent evidence on the prevalence, incidence, costs, activity limitations, and work limitations of common conditions requiring rehabilitation. DATA SOURCES: Medline (PubMed), SCOPUS, Web of Science, and the gray literature were searched for relevant articles about amputation, osteoarthritis, rheumatoid arthritis, back pain, multiple sclerosis, spinal cord injury, stroke, and traumatic brain injury. STUDY SELECTION: Relevant articles (N=106) were included. DATA EXTRACTION: Two investigators independently reviewed articles and selected relevant articles for inclusion. Quality grading was performed using the Methodological Evaluation of Observational Research Checklist and Newcastle-Ottawa Quality Assessment Form. DATA SYNTHESIS: The prevalence of back pain in the past 3 months was 33.9% among community-dwelling adults, and patients with back pain contribute $365 billion in all-cause medical costs. Osteoarthritis is the next most prevalent condition (approximately 10.4%), and patients with this condition contribute $460 billion in all-cause medical costs. These 2 conditions are the most prevalent and costly (medically) of the illnesses explored in this study. Stroke follows these conditions in both prevalence (2.5%-3.7%) and medical costs ($28 billion). Other conditions may have a lower prevalence but are associated with relatively higher per capita effects. CONCLUSIONS: Consistent with previous findings, back pain and osteoarthritis are the most prevalent conditions with high aggregate medical costs. By contrast, other conditions have a lower prevalence or cost but relatively higher per capita costs and effects on activity and work. The data are extremely heterogeneous, which makes anything beyond broad comparisons challenging. Additional information is needed to determine the relative impact of each condition.
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Absentismo , Gastos en Salud/estadística & datos numéricos , Rendimiento Físico Funcional , Amputación Quirúrgica/economía , Amputación Quirúrgica/estadística & datos numéricos , Artritis Reumatoide/economía , Artritis Reumatoide/epidemiología , Dolor de Espalda/economía , Dolor de Espalda/epidemiología , Lesiones Traumáticas del Encéfalo/economía , Lesiones Traumáticas del Encéfalo/epidemiología , Humanos , Incidencia , Esclerosis Múltiple/economía , Esclerosis Múltiple/epidemiología , Osteoartritis/economía , Osteoartritis/epidemiología , Prevalencia , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/epidemiología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Spinal trauma is common in polytrauma; spinal cord injury (SCI) is present in a subset of these patients. Penetrating SCI has been studied in the military; however, civilian SCI is less studied. Civilian injury pathophysiology varies given the generally lower velocity of the projectiles. We sought to investigate civilian penetrating SCI in the United States. METHODS: We queried the National Inpatient Sample for data regarding penetrating spinal cord injury from the past 10 years (2006-2015). The National Inpatient Sample includes data of 20% of discharged patients from U.S. hospitals. We analyzed trends of penetrating SCI regarding its diagnosis, demographics, surgical management, length of stay, and hospital costs. RESULTS: In the past 10 years the incidence of penetrating SCI in all SCI patients has remained stable with a mean of 5.5% (range 4.3%-6.6%). Of the patients with penetrating SCI, only 17% of them underwent a surgical procedure, compared with 55% for nonpenetrating SCI. Patients with penetrating SCI had a longer length of stay (average 23 days) compared with nonpenetrating SCI (15 days). Hospital charges were higher for penetrating SCI: $230,186 compared with $192,022 for closed SCI. Males patients were more affected by penetrating SCI, as well as black and Hispanic populations compared with whites. CONCLUSIONS: Penetrating SCI represents 5.5% of all SCI patients. Men, blacks, and Hispanics are disproportionally more affected by penetrating SCI. Patients with penetrating SCI have fewer surgical interventions, but their overall length of stay and hospital costs are greater compared with nonpenetrating SCI.
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Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Traumatismos de la Médula Espinal/epidemiología , Heridas Penetrantes/epidemiología , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Bases de Datos Factuales , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Precios de Hospital/estadística & datos numéricos , Humanos , Laminectomía/estadística & datos numéricos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/economía , Distribución por Sexo , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/terapia , Fusión Vertebral/estadística & datos numéricos , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricos , Heridas no Penetrantes/economía , Heridas no Penetrantes/epidemiología , Heridas no Penetrantes/terapia , Heridas Penetrantes/economía , Heridas Penetrantes/terapia , Adulto JovenRESUMEN
Persons experiencing disabilities often face difficulties to establish and maintain intimate partnerships and the decision whether to live alone or with others is often not their own to make. This study investigates whether individual and country-level characteristics predict the partnership status and the living situation of persons with spinal cord injury (SCI) from 22 countries. We used data from 12,591 participants of the International SCI Community Survey (InSCI) and regressed partnership status and living situation on individual (sociodemographic and injury characteristics) and country-level characteristics (Human Development Index, HDI) using multilevel models. Females, younger persons, those with lower income, without paid work, more severe injuries, and longer time since injury were more often single. Males, older persons, those with higher income, paid work, less severe injuries, and those from countries with higher HDI more often lived alone. This study provides initial evidence for the claim that the partnership status and the living situation of people with SCI are influenced by sociodemographic and socioeconomic factors and are not merely a matter of choice, in particular for those with severe injuries.
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Personas con Discapacidad , Traumatismos de la Médula Espinal , Adolescente , Adulto , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: We assessed the hypothesis that nonoperative management would be a viable treatment option for patients with underlying degenerative disease who have traumatic cervical spinal cord injury (TCSI) without neurological deterioration and/or spinal instability during hospitalization. METHODS: Data were collected prospectively from 2011 to 2016. All the patients had been treated nonoperatively with hard cervical collar immobilization. The clinical parameters assessed included the Frankel grade at presentation and discharge, the occurrence of deep vein thrombosis, urinary tract infection, sphincter dysfunction, and pressure sores. The radiographic data collected included magnetic resonance imaging signal cord changes. P ≤ 0.05 represented a significant association between the Frankel grade at presentation and the outcome parameters. RESULTS: A total of 28 patients were included in the present study. Of the patients who had presented with Frankel grade B, 85.71% had improved to a higher grade, 90.91% of the patients with Frankel grade C had improved to a higher grade, and 14.29% of the patients with Frankel grade D had improved to Frankel grade E. All the patients had satisfactory spinal stability, as evidenced by dynamic radiographs, after treatment. CONCLUSION: The findings from the present study have shown that nonoperative management can result in improved neurological outcomes for patients with underlying degenerative disease who have experienced TCSI without evidence of neurological deterioration and spinal instability. The Frankel grade at presentation was significantly associated with outcome parameters such as the neurological outcome on discharge and the occurrence of urinary tract infection. The results from the present study could be helpful to neurological surgeons in rural and other low-resource settings because the cost savings realized by nonoperative treatment will not sacrifice the provision of adequate care to their patients.
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Vértebras Cervicales/diagnóstico por imagen , Ahorro de Costo/métodos , Manejo de la Enfermedad , Degeneración del Disco Intervertebral/terapia , Atención al Paciente/métodos , Traumatismos de la Médula Espinal/terapia , Adulto , Anciano , Médula Cervical/diagnóstico por imagen , Médula Cervical/lesiones , Estudios de Cohortes , Ahorro de Costo/economía , Femenino , Humanos , Degeneración del Disco Intervertebral/diagnóstico por imagen , Degeneración del Disco Intervertebral/economía , Degeneración del Disco Intervertebral/epidemiología , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Atención al Paciente/economía , Estudios Prospectivos , Traumatismos de la Médula Espinal/diagnóstico por imagen , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/epidemiología , Resultado del TratamientoRESUMEN
Objective The aim of this study was to estimate the difference between treatment costs in acute care settings and the level of funding public hospitals would receive under the activity-based funding model. Methods Patients aged ≥16 years who had sustained an incident traumatic spinal cord injury (TSCI) between June 2013 and June 2016 in New South Wales were included in the study. Patients were identified from record-linked health data. Costs were estimated using two approaches: (1) using District Network Return (DNR) data; and (2) based on national weighted activity units (NWAU) assigned to activity-based funding activity. The funding gap in acute care treatment costs for TSCI patients was determined as the difference in cost estimates between the two approaches. Results Over the study period, 534 patients sustained an acute incident TSCI, accounting for 811 acute care hospital separations within index episodes. The total acute care treatment cost was estimated at A$40.5 million and A$29.9 million using the DNR- and NWAU-based methods respectively. The funding gap in total costs was greatest for the specialist spinal cord injury unit (SCIU) colocated with a major trauma service (MTS), at A$4.4 million over the study period. Conclusions The findings of this study suggest a substantial gap in funding for resource-intensive patients with TSCI in specialist hospitals under current DRG-based funding methods. What is known about the topic? DRG-based funding methods underestimate the treatment costs at the hospital level for patients with complex resource-intensive needs. This underestimation of true direct costs can lead to under-resourcing of those hospitals providing specialist services. What does this paper add? This study provides evidence of a difference between true direct costs in acute care settings and the level of funding hospitals would receive if funded according to the National Efficient Price and NWAU for patients with TSCI. The findings provide evidence of a shortfall in the casemix funding to public hospitals under the activity-based funding for resource-intensive care, such as patients with TSCI. Specifically, depending on the classification system, the principal referral hospitals, the SCIU colocated with an MTS and stand-alone SCIU were underfunded, whereas other non-specialist hospitals were overfunded for the acute care treatment of patients with TSCI. What are the implications for practitioners? Although health care financing mechanisms may vary internationally, the results of this study are applicable to other hospital payment systems based on diagnosis-related groups that describe patients of similar clinical characteristics and resource use. Such evidence is believed to be useful in understanding the adequacy of hospital payments and informing payment reform efforts. These findings may have service redesign policy implications and provide evidence for additional loadings for specialist hospitals treating low-volume, resource-intensive patients.
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Costos de la Atención en Salud/estadística & datos numéricos , Hospitales Públicos/economía , Hospitales Especializados/economía , Traumatismos de la Médula Espinal/economía , Adolescente , Adulto , Anciano , Australia , Costo de Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Gales del Sur , Traumatismos de la Médula Espinal/terapia , Adulto JovenRESUMEN
AIM: The aim of this study was to determine prognostic factors for medical and productivity costs, and return to work (RTW) during the first two years after trauma in a clinical trauma population. METHODS: This prospective multicentre observational study followed all adult trauma patients (≥18 years) admitted to a hospital in Noord-Brabant, the Netherlands from August 2015 through November 2016. Health care consumption, productivity loss and return to work were measured in questionnaires at 1 week, 1, 3, 6, 12 and 24 months after injury. Data was linked with hospital registries. Prognostic factors for medical costs and productivity costs were analysed with log-linked gamma generalized linear models. Prognostic factors for RTW were assessed with Cox proportional hazards model. The predictive ability of the models was assessed with McFadden R2 (explained variance) and c-statistics (discrimination). RESULTS: A total of 3785 trauma patients (39% of total study population) responded to at least one follow-up questionnaire. Mean medical costs per patient (9,710) and mean productivity costs per patient (9,000) varied widely. Prognostic factors for high medical costs were higher age, female gender, spine injury, lower extremity injury, severe head injury, high injury severity, comorbidities, and pre-injury health status. Productivity costs were highest in males, and in patients with spinal cord injury, high injury severity, longer length of stay at the hospital and patients admitted to the ICU. Prognostic factors for RTW were high educational level, male gender, low injury severity, shorter length of stay at the hospital and absence of comorbidity. CONCLUSIONS: Productivity costs and RTW should be considered when assessing the economic impact of injury in addition to medical costs. Prognostic factors may assist in identifying high cost groups with potentially modifiable factors for targeted preventive interventions, hence reducing costs and increasing RTW rates.
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Costo de Enfermedad , Reinserción al Trabajo/economía , Heridas y Lesiones/patología , Adolescente , Adulto , Anciano , Femenino , Estado de Salud , Humanos , Tiempo de Internación , Modelos Lineales , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/patología , Encuestas y Cuestionarios , Heridas y Lesiones/economía , Adulto JovenRESUMEN
STUDY DESIGN: Cross-sectional. OBJECTIVES: (1) Identify changes in employment status and earnings after spinal cord injury (SCI). (2) Estimate annual indirect costs and lifetime indirect costs due to lost earnings for various age and neurologic categories of those with SCI. (3) Compare our estimates with previous research. SETTING: Medical university in southeastern United States. METHODS: A population-based cohort of 307 participants met eligibility criteria of: (1) residual impairment resulting from traumatic SCI, (2) at least 1 year post injury, (3) between 23 and 64 years old at time of injury, (4) <65 years old at time of measurement, and (5) complete information on injury level, injury completeness, employment status, and earnings before and after injury. Main outcomes were employment status and earnings at the time of injury and post injury. Earnings were adjusted for inflation and the value of fringe benefits. RESULTS: Employment rate decreased from 87% at the time of injury to 35% after injury. Average annual indirect costs were $29,354 in 2019 dollars. Lifetime indirect costs for persons injured at age 25 varied by severity of injury, ranging from 0.5 to 2.3 million dollars. Lifetime indirect costs for persons injured at age 50 ranged from 0.3 to 0.6 million dollars. CONCLUSIONS: Our estimate of indirect costs is lower than the previously estimated number. However, the higher unemployment rate and decreased earnings after SCI still make a heavy economic burden. With improvements in employment outcomes after SCI, the indirect costs affecting individuals, their families, and society can be further reduced.
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Costo de Enfermedad , Empleo/estadística & datos numéricos , Renta/estadística & datos numéricos , Traumatismos de la Médula Espinal/economía , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Sudeste de Estados UnidosRESUMEN
The objectives of this study were to describe home care utilization and costs in community-dwelling individuals 2 years post-spinal cord injury (SCI) in Ontario, Canada. This retrospective incident cohort study uses administrative health care data to identify individuals with traumatic SCI (tSCI). Time to service delivery and frequency of service delivery and costs were calculated. A total of 798 individuals with tSCI comprised the cohort. In the first 2 years, personal support/homemaking was the most utilized service. Median cumulative home care 2 years post-discharge was $7,200 ($1,240-35,410 25-75% interquartile range). This study highlights the importance of home care to individuals with SCI.
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Servicios de Atención de Salud a Domicilio/economía , Traumatismos de la Médula Espinal/cirugía , Estudios de Cohortes , Femenino , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Ontario , Estudios Retrospectivos , Traumatismos de la Médula Espinal/economíaRESUMEN
STUDY DESIGN: Observational cross-sectional study. OBJECTIVES: To describe the most common prescription medications used and the extent of out-of-pocket cost, insurance coverage, and cost-related nonadherence (CRNA) for those medications by people with spinal cord injury (SCI) in Canada. SETTING: Community in Canada. METHODS: It was an observational study wherein data were collected through a cross-sectional online survey from individuals living with an SCI in Canada. We used descriptive statistics to describe the extent of drug cost, insurance coverage and CRNA among study sample, and analytical statistics to find association of CRNA with sociodemographic, injury-related and medication-related characteristics of the sample. RESULTS: Individuals with an SCI (n = 160) used an average of five medications and spent a median of $49 (interquartile range: $234.75) per month on their medications. More than 90% of participants had some form of drug insurance, though 37% reported CRNA. The most common medications that were forgone due to cost included opioids, antidepressants, and drugs for genitourinary and muscular spasms. Individuals with paraplegia and nontraumatic SCI had higher drug costs, though injury-related characteristics did not influence CRNA. Sex, monthly drug expenditure, and monthly additional healthcare costs were significantly associated with CRNA. CONCLUSIONS: People with SCIs are at risk of experiencing CRNA to their prescription medications despite having insurance coverage. Decision makers for the national pharmacare in Canada should account for their concerns judiciously.
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Prescripciones de Medicamentos , Gastos en Salud , Cobertura del Seguro , Seguro de Servicios Farmacéuticos , Cooperación del Paciente , Traumatismos de la Médula Espinal/tratamiento farmacológico , Traumatismos de la Médula Espinal/economía , Adulto , Canadá , Estudios Transversales , Prescripciones de Medicamentos/economía , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Gastos en Salud/estadística & datos numéricos , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Seguro de Servicios Farmacéuticos/economía , Seguro de Servicios Farmacéuticos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cooperación del Paciente/estadística & datos numéricosRESUMEN
BACKGROUND: To optimize traumatic spinal cord injury (tSCI) care, administrative and clinical linked data are required to describe the patient's journey. OBJECTIVES: To describe the methods and progress to deterministically link SCI data from multiple databases across the SCI continuum in British Columbia (BC) and Ontario (ON) to answer epidemiological and health service research questions. METHODS: Patients with tSCI will be identified from the administrative Hospital Discharge Abstract Database using International Classification of Diseases (ICD) codes from Population Data BC and ICES data repositories in BC and ON, respectively. Admissions for tSCI will range between 1995-2017 for BC and 2009-2017 for ON. Linkage will occur with multiple administrative data holdings from Population Data BC and ICES to create the "Admin SCI Cohorts." Clinical data from the Rick Hansen SCI Registry (and VerteBase in BC) will be transferred to Population Data BC and ICES. Linkage of the clinical data with the incident cases and administrative data at Population Data BC and ICES will create subsets of patients referred to as the "Clinical SCI Cohorts" for BC and ON. Deidentified patient-level linked data sets will be uploaded to a secure research environment for analysis. Data validation will include several steps, and data analysis plans will be created for each research question. DISCUSSION: The creation of provincially linked tSCI data sets is unique; both clinical and administrative data are included to inform the optimization of care across the SCI continuum. Methods and lessons learned will inform future data-linking projects and care initiatives.
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Registro Médico Coordinado/métodos , Aceptación de la Atención de Salud , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/terapia , Colombia Británica/epidemiología , Bases de Datos Factuales , Investigación sobre Servicios de Salud , Humanos , Ontario/epidemiología , Sistema de Registros , Traumatismos de la Médula Espinal/epidemiologíaRESUMEN
BACKGROUND: The aim of this study was to determine whether the implementation of a dedicated multiprofessional acute trauma health care (mPATH) team would decrease length of stay without adversely impacting outcomes of patients with severe traumatic brain and spinal cord injuries. The mPATH team was comprised of a physical, occupational, speech, and respiratory therapist, nurse navigator, social worker, advanced care provider, and physician who performed rounds on the subset of trauma patients with these injuries from the intensive care unit to discharge. METHODS: Following the formation and implementation of the mPATH team at our Level I trauma center, a retrospective cohort study was performed comparing patients in the year immediately prior to the introduction of the mPATH team (n = 60) to those in the first full year following implementation (n = 70). Demographics were collected for both groups. Inclusion criteria were Glasgow Coma Scale score less than 8 on postinjury Day 2, all paraplegic and quadriplegic patients, and patients older than 55 years with central cord syndrome who underwent tracheostomy. The primary endpoint was length of stay; secondary endpoints were time to tracheostomy, days to evaluation by occupational, physical, and speech therapy, 30-day readmission, and 30-day mortality. RESULTS: The median time to evaluation by occupational, physical, and speech therapy was universally decreased. Injury Severity Score was 27 in both cohorts. Time to tracheostomy and length of stay were both decreased. Thirty-day readmission and mortality rates remained unchanged. A cost savings of US $11,238 per index hospitalization was observed. CONCLUSION: In the year following the initiation of the mPATH team, we observed earlier time to occupational, physical, and speech therapist evaluation, decreased length of stay, and cost savings in severe traumatic brain and spinal cord injury patients requiring tracheostomy compared with our historical control. These benefits were observed without adversely impacting 30-day readmission or mortality. LEVEL OF EVIDENCE: Therapeutic/care management, Level III.
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Lesiones Traumáticas del Encéfalo/terapia , Tiempo de Internación/estadística & datos numéricos , Grupo de Atención al Paciente/organización & administración , Traumatismos de la Médula Espinal/terapia , Traqueostomía/estadística & datos numéricos , Centros Traumatológicos/organización & administración , Adolescente , Adulto , Anciano , Lesiones Traumáticas del Encéfalo/diagnóstico , Lesiones Traumáticas del Encéfalo/economía , Lesiones Traumáticas del Encéfalo/mortalidad , Ahorro de Costo , Femenino , Implementación de Plan de Salud , Mortalidad Hospitalaria , Humanos , Puntaje de Gravedad del Traumatismo , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/economía , Readmisión del Paciente/economía , Readmisión del Paciente/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/mortalidad , Factores de Tiempo , Tiempo de Tratamiento/estadística & datos numéricos , Traqueostomía/economía , Centros Traumatológicos/estadística & datos numéricos , Resultado del Tratamiento , Adulto JovenRESUMEN
Context: Medicaid has been linked to worse outcomes in a variety of diagnoses such as lung cancer, uterine cancer, and cardiac valve procedures. It has furthermore been linked to the reduced health-related quality of life outcomes after traumatic injuries when compared to other insurance groups. In spinal cord injury (SCI), the care provided in the subacute setting may vary based upon payor status, which may have implications on outcomes and cost of care.Design: A retrospective review utilizing the institutional trauma databank was performed for all adult patients with spinal cord injury since 2009. Pediatric patients were excluded. Insurance type, race, length of stay, discharge status (alive/dead), discharge disposition, injury severity score (ISS), and hospital charges billed were recorded.Results: Two hundred patients were identified. Overall 27.5% of patients with SCI during the period of our review were Medicaid beneficiaries. ISS was similar between Medicaid and non-Medicaid patients, but the Medicaid beneficiaries were younger (37 vs 50 years of age; P < .001). Medicaid beneficiaries had a significantly longer length of stay (20.9 days; P < .001) when compared to all other patients. They furthermore were more likely to be discharged home or to a skilled nursing facility rather than an acute rehabilitation center. Inpatient charges billed for Medicaid beneficiaries were significantly higher than those of non-Medicaid patients (203,264 USD vs 140,114 USD; P = .015), likely reflecting the increased length of stay while awaiting appropriate disposition.Conclusion: Medicaid patients with SCI in West Virginia had a longer hospital stay, higher charges billed, and were more likely to be discharged home or to a skilled nursing facility rather than an acute rehabilitation center, when compared to non-Medicaid patients. The lack of availability of rehabilitation facilities for Medicaid beneficiaries likely explains this difference.
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Disparidades en Atención de Salud , Hospitales/estadística & datos numéricos , Seguro/economía , Alta del Paciente/estadística & datos numéricos , Traumatismos de la Médula Espinal , Factores de Edad , Bases de Datos Factuales , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Medicaid , Persona de Mediana Edad , Centros de Rehabilitación/estadística & datos numéricos , Estudios Retrospectivos , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricos , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/rehabilitación , Estados Unidos , West VirginiaRESUMEN
Life care planning is a method of estimating future care costs for patients with catastrophic disabilities. The life care planner determines an annual budget for care, including further medical and rehabilitative interventions, durable medical goods, disposable medical goods and supplies, and recreational equipment. After determining an annual budget, the life care planner must use scientifically sound methods of determining the patient's life expectancy in order to create a lifetime budget.
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Costos y Análisis de Costo/métodos , Evaluación de la Discapacidad , Predicción/métodos , Personas con Discapacidad , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/terapiaRESUMEN
STUDY DESIGN: Economic modelling analysis. OBJECTIVES: To determine lifetime direct and indirect costs from initial hospitalisation of all expected new traumatic and non-traumatic spinal cord injuries (SCI) over 12 months. SETTING: United Kingdom (UK). METHODS: Incidence-based approach to assessing costs from a societal perspective, including immediate and ongoing health, rehabilitation and long-term care directly attributable to SCI, as well as aids and adaptations, unpaid informal care and participation in employment. The model accounts for differences in injury severity, gender, age at onset and life expectancy. RESULTS: Lifetime costs for an expected 1270 new cases of SCI per annum conservatively estimated as £1.43 billion (2016 prices). This equates to a mean £1.12 million (median £0.72 million) per SCI case, ranging from £0.47 million (median £0.40 million) for an AIS grade D injury to £1.87 million (median £1.95 million) for tetraplegia AIS A-C grade injuries. Seventy-one percent of lifetime costs potentially are paid by the public purse with remaining costs due to reduced employment and carer time. CONCLUSIONS: Despite the magnitude of costs, and being comparable with international estimates, this first analysis of SCI costs in the UK is likely to be conservative. Findings are particularly sensitive to the level and costs of long-term home and residential care. The analysis demonstrates how modelling can be used to highlight economic impacts of SCI rapidly to policymakers, illustrate how changes in future patterns of injury influence costs and help inform future economic evaluations of actions to prevent and/or reduce the impact of SCIs.
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Análisis Costo-Beneficio/tendencias , Costos de la Atención en Salud/tendencias , Modelos Económicos , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Análisis Costo-Beneficio/métodos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Traumatismos de la Médula Espinal/terapia , Reino Unido/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: Spinal trauma is a major cause of disability worldwide. The burden is especially severe in low-income countries, where hospital infrastructure is poor, resources are limited, and the volume of cases is high. Currently, there are no reliable data available on incidence, management, and outcomes of spinal trauma in East Africa. The main objective of this study was to describe, for the first time, the demographics, management, costs of surgery and implants, treatment decision factors, and outcomes of patients with spine trauma in Tanzania. METHODS: The authors retrospectively reviewed prospectively collected data on spinal trauma patients in the single surgical referral center in Tanzania (Muhimbili Orthopaedic Institute [MOI]) from October 2016 to December 2017. They collected general demographics and the following information: distance from site of trauma to the center, American Spinal Injury Association Impairment Scale (AIS), time to surgery, steroid use, and mechanism of trauma and AOSpine classification and costs. Surgical details and complications were recorded. Primary outcome was neurological status on discharge. The authors analyzed surgical outcome and determined predicting factors for positive outcome. RESULTS: A total of 180 patients were included and analyzed in this study. The mean distance from site of trauma to MOI was 278.0 km, and the time to admission was on average 5.9 days after trauma. Young males were primarily affected (82.8% males, average age 35.7 years). On admission, 47.2% of patients presented with AIS grade A. Most common mechanisms of injury were motor vehicle accidents (28.9%) and falls from height (32.8%). Forty percent of admitted patients underwent surgery. The mean time to surgery was 33.2 days; 21.4% of patients who underwent surgery improved in AIS grade at discharge (p = 0.030). Overall, the only factor associated with improvement in neurological status was undergoing surgery (p = 0.03) and shorter time to surgery (p = 0.02). CONCLUSIONS: This is the first study to describe the management and outcomes of spinal trauma in East Africa. Due to the lack of referral hospitals, patients are admitted late after trauma, often with severe neurological deficit. Surgery is performed but generally late in the course of hospital stay. The decision to perform surgery and timing are heavily influenced by the availability of implants and economic factors such as insurance status. Patients with incomplete deficits who may benefit most from surgery are not prioritized. The authors' results suggest that surgery may have a positive impact on patient outcome. Further studies with a larger sample size are needed to confirm our results. These results provide strong support to implement evidence-based protocols for the management of spinal trauma.
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Traumatismos de la Médula Espinal/terapia , Traumatismos Vertebrales/terapia , Adulto , Toma de Decisiones Clínicas , Manejo de la Enfermedad , Femenino , Geografía Médica , Humanos , Tiempo de Internación , Masculino , Estudios Prospectivos , Estudios Retrospectivos , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/epidemiología , Traumatismos Vertebrales/economía , Traumatismos Vertebrales/epidemiología , Tanzanía/epidemiología , Resultado del TratamientoRESUMEN
OBJECTIVE: The objective of this study was to investigate the effect of hospital type and patient transfer during the treatment of patients with vertebral fracture and/or spinal cord injury (SCI). METHODS: The National Inpatient Sample (NIS) database was queried to identify patients treated in Utah from 2001 to 2011 for vertebral column fracture and/or SCI (ICD-9-CM codes 805, 806, and 952). Variables related to patient transfer into and out of the index hospital were evaluated in relation to patient disposition, hospital length of stay, mortality, and cost. RESULTS: A total of 53,644 patients were seen (mean [± SEM] age 55.3 ± 0.1 years, 46.0% females, 90.2% white), of which 10,620 patients were transferred from another institution rather than directly admitted. Directly admitted (vs transferred) patients showed a greater likelihood of routine disposition (54.4% vs 26.0%) and a lower likelihood of skilled nursing facility disposition (28.2% vs 49.2%) (p < 0.0001). Directly admitted patients also had a significantly shorter length of stay (5.6 ± 6.7 vs 7.8 ± 9.5 days, p < 0.0001) and lower total charges ($26,882 ± $37,348 vs $42,965 ± $52,118, p < 0.0001). A multivariable analysis showed that major operative procedures (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.4-2.0, p < 0.0001) and SCI (HR 2.1, 95% CI 1.6-2.8, p < 0.0001) were associated with reduced survival whereas patient transfer was associated with better survival rates (HR 0.4, 95% CI 0.3-0.5, p < 0.0001). A multivariable analysis of cost showed that disposition (ß = 0.1), length of stay (ß = 0.6), and major operative procedure (ß = 0.3) (p < 0.0001) affected cost the most. CONCLUSIONS: Overall, transferred patients had lower mortality but greater likelihood for poor outcomes, longer length of stay, and higher cost compared with directly admitted patients. These results suggest some significant benefits to transferring patients with acute injury to facilities capable of providing appropriate treatment, but also support the need to further improve coordinated care of transferred patients, including surgical treatment and rehabilitation.