TY - JOUR
T1 - Implementation and initial outcomes of a spinal cord injury home care program at a large veterans affairs medical center
AU - Sippel, Jennifer L.
AU - Bozeman, Sara M.
AU - Bradshaw, Ledjona
AU - Cipher, Daisha J.
AU - McCarthy, Michael
AU - Wickremasinghe, Itala M.
N1 - Publisher Copyright:
©, This work was authored as part of the Contributor's official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law.
PY - 2019/3/4
Y1 - 2019/3/4
N2 - Objectives: Describe an interdisciplinary spinal cord injury home care program (SCIHCP), sample demographics for the veteran participants, and initial impact of SCIHCP on health care utilization and mortality. Design: Retrospective review. Setting: SCIHCP of the Spinal Cord Injury Center, VA North Texas Health Care System (VANTHCS). Participants: Patients with SCI/D enrolled in the SCIHCP during January 6, 2006 through January 9, 2012, whose injury occurred at least one year prior to enrollment(n = 125). Main Outcome Measures: VANTHCS hospital admissions, length of stay (LOS), and emergency department (ED) visits evaluated one year before and one year after SCIHCP enrollment; mortality evaluated one-year post-enrollment. Results: There were no significant changes in number of ED visits, number of hospital admissions, or LOS over time. More home care visits and more mental health comorbidities predicted more hospital admissions. Older patients and those with more mental health comorbidities were more likely to experience increases in LOS. These prediction models were significant after adjusting for injury level, age, race, time since SCI, and number of medical comorbidities. More home care visits were associated with lower likelihood of mortality post-enrollment. Conclusions: Inpatient and ED utilization did not change one year after enrollment, but more SCIHCP visits predicted more hospital admissions and lower likelihood of mortality in the post-evaluation year. The support, education, and care continuity SCIHCP generates might be related to increased inpatient access and lower mortality rate. Veterans with increased mental health comorbidities used inpatient services more, and might need additional support.
AB - Objectives: Describe an interdisciplinary spinal cord injury home care program (SCIHCP), sample demographics for the veteran participants, and initial impact of SCIHCP on health care utilization and mortality. Design: Retrospective review. Setting: SCIHCP of the Spinal Cord Injury Center, VA North Texas Health Care System (VANTHCS). Participants: Patients with SCI/D enrolled in the SCIHCP during January 6, 2006 through January 9, 2012, whose injury occurred at least one year prior to enrollment(n = 125). Main Outcome Measures: VANTHCS hospital admissions, length of stay (LOS), and emergency department (ED) visits evaluated one year before and one year after SCIHCP enrollment; mortality evaluated one-year post-enrollment. Results: There were no significant changes in number of ED visits, number of hospital admissions, or LOS over time. More home care visits and more mental health comorbidities predicted more hospital admissions. Older patients and those with more mental health comorbidities were more likely to experience increases in LOS. These prediction models were significant after adjusting for injury level, age, race, time since SCI, and number of medical comorbidities. More home care visits were associated with lower likelihood of mortality post-enrollment. Conclusions: Inpatient and ED utilization did not change one year after enrollment, but more SCIHCP visits predicted more hospital admissions and lower likelihood of mortality in the post-evaluation year. The support, education, and care continuity SCIHCP generates might be related to increased inpatient access and lower mortality rate. Veterans with increased mental health comorbidities used inpatient services more, and might need additional support.
KW - Emergency medical services
KW - Home care services
KW - Home care services hospitals
KW - Hospitalization
KW - Length of stay
KW - Organizational case studies
KW - Retrospective studies
KW - Spinal cord diseases
KW - Spinal cord injuries
KW - United States Department of Veterans Affairs
KW - Veterans
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U2 - 10.1080/10790268.2018.1485311
DO - 10.1080/10790268.2018.1485311
M3 - Article
C2 - 29965795
AN - SCOPUS:85049589322
SN - 1079-0268
VL - 42
SP - 155
EP - 162
JO - Journal of Spinal Cord Medicine
JF - Journal of Spinal Cord Medicine
IS - 2
ER -