Article

Persons with spinal cord injury (SCI) living in the community have
high health care utilization (HCU). To date, the interrelationships among
multiple secondary health conditions (multimorbidity due to comorbidities and
complications) that drive HCU and their impact on patient outcomes are unknown.
OBJECTIVE: To determine the association among multimorbidity, HCU, health status,
and quality of life. METHODS: Community-dwelling persons with traumatic SCI
participated in an online/phone SCI Community Survey. Participants were grouped
using the 7-item HCU questionnaire (group 1 did not receive needed care and/or
rehospitalized; group 2 received needed care but rehospitalized; group 3 received
needed care and not rehospitalized). Personal, injury, and environmental factors;
multimorbidity (presence/absence of 30 comorbidities/ complications); health
status (Short Form-12); and quality of life measures (Life Satisfaction-11 first
question and single-item quality of life measure) were collected. Associations
among these variables were assessed using multivariate analysis. RESULTS: The
1,137 survey participants were divided into 3 groups: group 1 (n = 292), group 2
(n = 194), and group 3 (n = 650). Group 1 had the greatest number of secondary
health conditions (15.14 +/- 3.86) followed by group 2 (13.60 +/- 4.00) and group
3 (12.00 +/- 4.16) (P < .05). Multimorbidity and HCU were significant risk
factors for having a lower SF-12 Mental (P < .001) and Physical Component Score
(P < .001). They in turn were associated with participants reporting a lower
quality of life (P < .001, for both questions). CONCLUSIONS: Multimorbidity and
HCU are interrelated and associated with lower health status, which in turn is
associated with lower quality of life. Future work will include the development
of a screening tool to identify persons with SCI at risk of inappropriate HCU
(eg, rehospitalization, not able to access care), which should lead to better
patient outcomes and cost savings.

Langue : ANGLAIS