Influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States
Background: Discharge to acute rehabilitation is strongly correlated with functional recovery after traumatic injury, including spinal cord injury (SCI). However, services such as acute care rehabilitation and Skilled Nursing Facilities (SNF) are expensive. Our objective was to understand if high-co...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-12-01
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| Series: | North American Spine Society Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548422000890 |
| _version_ | 1811292674149318656 |
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| author | Matthew J. Hagan Nathan J. Pertsch Owen P. Leary Arjun Ganga Rahul Sastry Kevin Xi Bryan Zheng Mark Behar Joaquin Q. Camara-Quintana Tianyi Niu Patricia Zadnik Sullivan Jose Fernandez Abinader Albert E. Telfeian Ziya L. Gokaslan Adetokunbo A. Oyelese Jared S. Fridley |
| author_facet | Matthew J. Hagan Nathan J. Pertsch Owen P. Leary Arjun Ganga Rahul Sastry Kevin Xi Bryan Zheng Mark Behar Joaquin Q. Camara-Quintana Tianyi Niu Patricia Zadnik Sullivan Jose Fernandez Abinader Albert E. Telfeian Ziya L. Gokaslan Adetokunbo A. Oyelese Jared S. Fridley |
| author_sort | Matthew J. Hagan |
| collection | DOAJ |
| description | Background: Discharge to acute rehabilitation is strongly correlated with functional recovery after traumatic injury, including spinal cord injury (SCI). However, services such as acute care rehabilitation and Skilled Nursing Facilities (SNF) are expensive. Our objective was to understand if high-cost, resource-intensive post-discharge rehabilitation or alternative care facilities are utilized at disparate rates across socioeconomic groups after SCI. Methods: We performed a cohort analysis using the National Trauma Data Bank® tabulated from 2012-2016. Eligible patients had a diagnosis of cervical or thoracic spine fracture with spinal cord injury (SCI) and were treated surgically. We evaluated associations of sociodemographic and psychosocial variables with non-home discharge (e.g., discharge to SNF, other healthcare facility, or intermediate care facility) via multivariable logistic regression while correcting for injury severity and hospital characteristics. Results: We identified 3933 eligible patients. Patients who were older, male (OR=1.29 95% Confidence Interval [1.07-1.56], p=.007), insured by Medicare (OR=1.45 [1.08-1.96], p=.015), diagnosed with a major psychiatric disorder (OR=1.40 [1.03-1.90], p=.034), had a higher Injury Severity Score (OR=5.21 [2.96-9.18], p<.001) or a lower Glasgow Coma Score (3–8 points, OR=2.78 [1.81-4.27], p<.001) had a higher chance of a non-home discharge. The only sociodemographic variable associated with lower likelihood of utilizing additional healthcare facilities following discharge was uninsured status (OR=0.47 [0.37-0.60], p<.001). Conclusions: Uninsured patients are less likely to be discharged to acute rehabilitation or alternative healthcare facilities following surgical management of SCI. High out-of-pocket costs for uninsured patients in the United States may deter utilization of these services. |
| first_indexed | 2024-04-13T04:48:55Z |
| format | Article |
| id | doaj.art-911518fda9b044419511520936751e23 |
| institution | Directory Open Access Journal |
| issn | 2666-5484 |
| language | English |
| last_indexed | 2024-04-13T04:48:55Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | North American Spine Society Journal |
| spelling | doaj.art-911518fda9b044419511520936751e232022-12-22T03:01:45ZengElsevierNorth American Spine Society Journal2666-54842022-12-0112100186Influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United StatesMatthew J. Hagan0Nathan J. Pertsch1Owen P. Leary2Arjun Ganga3Rahul Sastry4Kevin Xi5Bryan Zheng6Mark Behar7Joaquin Q. Camara-Quintana8Tianyi Niu9Patricia Zadnik Sullivan10Jose Fernandez Abinader11Albert E. Telfeian12Ziya L. Gokaslan13Adetokunbo A. Oyelese14Jared S. Fridley15The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USADepartment of Neurosurgery, Rush University Medical Center, 600 S. Paulina St, Chicago, IL 60612, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USABrown University School of Public Health, 121 S Main St, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USAThe Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA; Corresponding author.Background: Discharge to acute rehabilitation is strongly correlated with functional recovery after traumatic injury, including spinal cord injury (SCI). However, services such as acute care rehabilitation and Skilled Nursing Facilities (SNF) are expensive. Our objective was to understand if high-cost, resource-intensive post-discharge rehabilitation or alternative care facilities are utilized at disparate rates across socioeconomic groups after SCI. Methods: We performed a cohort analysis using the National Trauma Data Bank® tabulated from 2012-2016. Eligible patients had a diagnosis of cervical or thoracic spine fracture with spinal cord injury (SCI) and were treated surgically. We evaluated associations of sociodemographic and psychosocial variables with non-home discharge (e.g., discharge to SNF, other healthcare facility, or intermediate care facility) via multivariable logistic regression while correcting for injury severity and hospital characteristics. Results: We identified 3933 eligible patients. Patients who were older, male (OR=1.29 95% Confidence Interval [1.07-1.56], p=.007), insured by Medicare (OR=1.45 [1.08-1.96], p=.015), diagnosed with a major psychiatric disorder (OR=1.40 [1.03-1.90], p=.034), had a higher Injury Severity Score (OR=5.21 [2.96-9.18], p<.001) or a lower Glasgow Coma Score (3–8 points, OR=2.78 [1.81-4.27], p<.001) had a higher chance of a non-home discharge. The only sociodemographic variable associated with lower likelihood of utilizing additional healthcare facilities following discharge was uninsured status (OR=0.47 [0.37-0.60], p<.001). Conclusions: Uninsured patients are less likely to be discharged to acute rehabilitation or alternative healthcare facilities following surgical management of SCI. High out-of-pocket costs for uninsured patients in the United States may deter utilization of these services.http://www.sciencedirect.com/science/article/pii/S2666548422000890Discharge dispositionInsurance statusHealthcare utilizationSocioeconomicSpinal cord injuryTrauma |
| spellingShingle | Matthew J. Hagan Nathan J. Pertsch Owen P. Leary Arjun Ganga Rahul Sastry Kevin Xi Bryan Zheng Mark Behar Joaquin Q. Camara-Quintana Tianyi Niu Patricia Zadnik Sullivan Jose Fernandez Abinader Albert E. Telfeian Ziya L. Gokaslan Adetokunbo A. Oyelese Jared S. Fridley Influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States North American Spine Society Journal Discharge disposition Insurance status Healthcare utilization Socioeconomic Spinal cord injury Trauma |
| title | Influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States |
| title_full | Influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States |
| title_fullStr | Influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States |
| title_full_unstemmed | Influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States |
| title_short | Influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States |
| title_sort | influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level i and ii trauma centers in the united states |
| topic | Discharge disposition Insurance status Healthcare utilization Socioeconomic Spinal cord injury Trauma |
| url | http://www.sciencedirect.com/science/article/pii/S2666548422000890 |
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