Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation

Gerben Dejong, Wenqiang Tian, Ching Hui Hsieh, Cherry Junn, Christopher Karam, Pamela H. Ballard, Randall J. Smout, Susan D. Horn, Jeanne M. Zanca, Allen W. Heinemann, Flora M. Hammond, Deborah Backus

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Objective: To determine rates of rehospitalization among discharged rehabilitation patients with traumatic spinal cord injury (SCI) in the first 12 months postinjury, and to identify factors associated with rehospitalization. Design: Prospective observational cohort study. Setting: Six geographically dispersed rehabilitation centers in the U.S. Participants: Consecutively enrolled individuals with new traumatic SCI (N=951), who were discharged from participating rehabilitation centers and participated in a 1-year follow-up survey. Interventions: Not applicable. Main Outcome Measures: Occurrence of postrehabilitation rehospitalization within 1 year of injury, length of rehospitalization stays, and causes of rehospitalizations. Results: More than one third (36.2%) of participants were rehospitalized at least once in the 12-month follow-up period; 12.5% were rehospitalized at least twice. The average number of rehospitalizations among those rehospitalized at least once was 1.37 times, with an average length of stay (LOS) of 15.5 days across all rehospitalization episodes. The 3 most common health conditions associated with rehospitalization were those related to the genitourinary system (eg, urinary tract infection), respiratory system (eg, pneumonia), and skin and subcutaneous tissue (eg, pressure ulcer). Being a woman (95% confidence interval [CI], 1.034-2.279), having Medicaid as the main payer (95% CI, 1.303-2.936), and more severe case mix were associated with increased odds of rehospitalization. Those who had more intensive physical therapy (95% CI,.960-.981) had lower odds of rehospitalization. Some center-to-center variation in rehospitalization rates remained unexplained after case mix and practice differences were considered. The 6 SCI rehabilitation centers varied nearly 2-fold in rates at which their former SCI patients were rehospitalized - from 27.8% to 50%. Center-to-center variation diminished when patient case mix was considered. Conclusions: Compared with earlier studies, rehospitalization rates among individuals with SCI in the first postinjury year remain high and vary by level and completeness of injury. Rehospitalization risk was associated with younger age, being a woman, unemployment and retirement, and Medicaid coverage. Those who had more intensive physical therapy had lower odds of rehospitalization. Future studies should examine center-to-center variations in rehospitalization rates and availability of patient education and community resources.

Original languageEnglish (US)
Pages (from-to)S87-S97
JournalArchives of physical medicine and rehabilitation
Volume94
Issue number4 SUPPL.
DOIs
StatePublished - Apr 1 2013

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Spinal Cord Injuries
Rehabilitation
Rehabilitation Centers
Diagnosis-Related Groups
Medicaid
Confidence Intervals
Length of Stay
Urogenital System
Unemployment
Pressure Ulcer
Retirement
Subcutaneous Tissue
Wounds and Injuries
Patient Education
Urinary Tract Infections
Respiratory System
Observational Studies
Pneumonia
Cohort Studies
Outcome Assessment (Health Care)

Keywords

  • Patient readmission
  • Rehabilitation
  • Spinal cord injuries

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation. / Dejong, Gerben; Tian, Wenqiang; Hsieh, Ching Hui; Junn, Cherry; Karam, Christopher; Ballard, Pamela H.; Smout, Randall J.; Horn, Susan D.; Zanca, Jeanne M.; Heinemann, Allen W.; Hammond, Flora M.; Backus, Deborah.

In: Archives of physical medicine and rehabilitation, Vol. 94, No. 4 SUPPL., 01.04.2013, p. S87-S97.

Research output: Contribution to journalArticle

Dejong, G, Tian, W, Hsieh, CH, Junn, C, Karam, C, Ballard, PH, Smout, RJ, Horn, SD, Zanca, JM, Heinemann, AW, Hammond, FM & Backus, D 2013, 'Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation', Archives of physical medicine and rehabilitation, vol. 94, no. 4 SUPPL., pp. S87-S97. https://doi.org/10.1016/j.apmr.2012.10.037
Dejong, Gerben ; Tian, Wenqiang ; Hsieh, Ching Hui ; Junn, Cherry ; Karam, Christopher ; Ballard, Pamela H. ; Smout, Randall J. ; Horn, Susan D. ; Zanca, Jeanne M. ; Heinemann, Allen W. ; Hammond, Flora M. ; Backus, Deborah. / Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation. In: Archives of physical medicine and rehabilitation. 2013 ; Vol. 94, No. 4 SUPPL. pp. S87-S97.
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abstract = "Objective: To determine rates of rehospitalization among discharged rehabilitation patients with traumatic spinal cord injury (SCI) in the first 12 months postinjury, and to identify factors associated with rehospitalization. Design: Prospective observational cohort study. Setting: Six geographically dispersed rehabilitation centers in the U.S. Participants: Consecutively enrolled individuals with new traumatic SCI (N=951), who were discharged from participating rehabilitation centers and participated in a 1-year follow-up survey. Interventions: Not applicable. Main Outcome Measures: Occurrence of postrehabilitation rehospitalization within 1 year of injury, length of rehospitalization stays, and causes of rehospitalizations. Results: More than one third (36.2{\%}) of participants were rehospitalized at least once in the 12-month follow-up period; 12.5{\%} were rehospitalized at least twice. The average number of rehospitalizations among those rehospitalized at least once was 1.37 times, with an average length of stay (LOS) of 15.5 days across all rehospitalization episodes. The 3 most common health conditions associated with rehospitalization were those related to the genitourinary system (eg, urinary tract infection), respiratory system (eg, pneumonia), and skin and subcutaneous tissue (eg, pressure ulcer). Being a woman (95{\%} confidence interval [CI], 1.034-2.279), having Medicaid as the main payer (95{\%} CI, 1.303-2.936), and more severe case mix were associated with increased odds of rehospitalization. Those who had more intensive physical therapy (95{\%} CI,.960-.981) had lower odds of rehospitalization. Some center-to-center variation in rehospitalization rates remained unexplained after case mix and practice differences were considered. The 6 SCI rehabilitation centers varied nearly 2-fold in rates at which their former SCI patients were rehospitalized - from 27.8{\%} to 50{\%}. Center-to-center variation diminished when patient case mix was considered. Conclusions: Compared with earlier studies, rehospitalization rates among individuals with SCI in the first postinjury year remain high and vary by level and completeness of injury. Rehospitalization risk was associated with younger age, being a woman, unemployment and retirement, and Medicaid coverage. Those who had more intensive physical therapy had lower odds of rehospitalization. Future studies should examine center-to-center variations in rehospitalization rates and availability of patient education and community resources.",
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AU - Dejong, Gerben

AU - Tian, Wenqiang

AU - Hsieh, Ching Hui

AU - Junn, Cherry

AU - Karam, Christopher

AU - Ballard, Pamela H.

AU - Smout, Randall J.

AU - Horn, Susan D.

AU - Zanca, Jeanne M.

AU - Heinemann, Allen W.

AU - Hammond, Flora M.

AU - Backus, Deborah

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N2 - Objective: To determine rates of rehospitalization among discharged rehabilitation patients with traumatic spinal cord injury (SCI) in the first 12 months postinjury, and to identify factors associated with rehospitalization. Design: Prospective observational cohort study. Setting: Six geographically dispersed rehabilitation centers in the U.S. Participants: Consecutively enrolled individuals with new traumatic SCI (N=951), who were discharged from participating rehabilitation centers and participated in a 1-year follow-up survey. Interventions: Not applicable. Main Outcome Measures: Occurrence of postrehabilitation rehospitalization within 1 year of injury, length of rehospitalization stays, and causes of rehospitalizations. Results: More than one third (36.2%) of participants were rehospitalized at least once in the 12-month follow-up period; 12.5% were rehospitalized at least twice. The average number of rehospitalizations among those rehospitalized at least once was 1.37 times, with an average length of stay (LOS) of 15.5 days across all rehospitalization episodes. The 3 most common health conditions associated with rehospitalization were those related to the genitourinary system (eg, urinary tract infection), respiratory system (eg, pneumonia), and skin and subcutaneous tissue (eg, pressure ulcer). Being a woman (95% confidence interval [CI], 1.034-2.279), having Medicaid as the main payer (95% CI, 1.303-2.936), and more severe case mix were associated with increased odds of rehospitalization. Those who had more intensive physical therapy (95% CI,.960-.981) had lower odds of rehospitalization. Some center-to-center variation in rehospitalization rates remained unexplained after case mix and practice differences were considered. The 6 SCI rehabilitation centers varied nearly 2-fold in rates at which their former SCI patients were rehospitalized - from 27.8% to 50%. Center-to-center variation diminished when patient case mix was considered. Conclusions: Compared with earlier studies, rehospitalization rates among individuals with SCI in the first postinjury year remain high and vary by level and completeness of injury. Rehospitalization risk was associated with younger age, being a woman, unemployment and retirement, and Medicaid coverage. Those who had more intensive physical therapy had lower odds of rehospitalization. Future studies should examine center-to-center variations in rehospitalization rates and availability of patient education and community resources.

AB - Objective: To determine rates of rehospitalization among discharged rehabilitation patients with traumatic spinal cord injury (SCI) in the first 12 months postinjury, and to identify factors associated with rehospitalization. Design: Prospective observational cohort study. Setting: Six geographically dispersed rehabilitation centers in the U.S. Participants: Consecutively enrolled individuals with new traumatic SCI (N=951), who were discharged from participating rehabilitation centers and participated in a 1-year follow-up survey. Interventions: Not applicable. Main Outcome Measures: Occurrence of postrehabilitation rehospitalization within 1 year of injury, length of rehospitalization stays, and causes of rehospitalizations. Results: More than one third (36.2%) of participants were rehospitalized at least once in the 12-month follow-up period; 12.5% were rehospitalized at least twice. The average number of rehospitalizations among those rehospitalized at least once was 1.37 times, with an average length of stay (LOS) of 15.5 days across all rehospitalization episodes. The 3 most common health conditions associated with rehospitalization were those related to the genitourinary system (eg, urinary tract infection), respiratory system (eg, pneumonia), and skin and subcutaneous tissue (eg, pressure ulcer). Being a woman (95% confidence interval [CI], 1.034-2.279), having Medicaid as the main payer (95% CI, 1.303-2.936), and more severe case mix were associated with increased odds of rehospitalization. Those who had more intensive physical therapy (95% CI,.960-.981) had lower odds of rehospitalization. Some center-to-center variation in rehospitalization rates remained unexplained after case mix and practice differences were considered. The 6 SCI rehabilitation centers varied nearly 2-fold in rates at which their former SCI patients were rehospitalized - from 27.8% to 50%. Center-to-center variation diminished when patient case mix was considered. Conclusions: Compared with earlier studies, rehospitalization rates among individuals with SCI in the first postinjury year remain high and vary by level and completeness of injury. Rehospitalization risk was associated with younger age, being a woman, unemployment and retirement, and Medicaid coverage. Those who had more intensive physical therapy had lower odds of rehospitalization. Future studies should examine center-to-center variations in rehospitalization rates and availability of patient education and community resources.

KW - Patient readmission

KW - Rehabilitation

KW - Spinal cord injuries

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