Article

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.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS