Concentration of Costs Among High Utilizers of Health Care Services Over the First 10 Years After Spinal Cord Injury Rehabilitation

A Population-based Study

James S. Krause, David Murday, Elizabeth Corley, Nicole D. DiPiro

Research output: Contribution to journalArticle

Abstract

Objective: The purpose of this study was to (1) categorize individuals into high, medium, and low utilizers of health care services over a 10-year period after the onset of spinal cord injury (SCI) and (2) identify the pattern of causes of hospitalizations and the characteristics associated with high utilization. Design: Retrospective analysis of self-report assessment linked to administrative data. Setting: Data were collected from participants living in and utilizing hospitals in the state of South Carolina. Participants: Adult participants with traumatic SCI were identified through a state SCI Surveillance System Registry, a population-based system capturing all incident cases treated in nonfederal facilities. Among 963 participants who completed self-report assessments, we matched those with a minimum of 10 years of administrative records for a final sample of 303 participants (N=303). Interventions: Not applicable. Main Outcome Measures: Costs related to health care utilization for emergency department visits and hospitalizations, as measured operationally by hospital charges at full and established rates; causes of hospitalizations Results: Over two-thirds of the total $49.4 million in charges for hospitalization over the 10-year timeframe (69%) occurred among 16.5% of the cohort (high utilizers), whereas those in the low utilizer group comprised 53% of the cohort with only 3.5% of the charges. The primary diagnoses were septicemia (50%), other urinary tract disorder (48%), mechanical complication of device, implant, or graft (48%), and chronic ulcer of skin (40%). Primary diagnoses were frequently accompanied by secondary diagnoses, indicating the co-occurrence of multiple secondary health conditions. High utilizers were more likely to be male, minority, have a severe SCI, have reported frequent pressure ulcers and have income of less than $35,000 per year. Conclusions: The high cost of chronic health care utilization over a 10-year timeframe was concentrated in a relatively small portion of the SCI population who have survived more than a decade after SCI onset.

Original languageEnglish (US)
JournalArchives of Physical Medicine and Rehabilitation
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

Fingerprint

Spinal Cord Injuries
Health Services
Rehabilitation
Delivery of Health Care
Costs and Cost Analysis
Hospitalization
Patient Acceptance of Health Care
Population
Self Report
Skin Ulcer
Hospital Charges
State Hospitals
Pressure Ulcer
Urinary Tract
Registries
Hospital Emergency Service
Sepsis
Outcome Assessment (Health Care)
Transplants
Equipment and Supplies

Keywords

  • Health care costs
  • Hospitalization
  • Rehabilitation
  • Spinal cord injuries

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

@article{c2083ef513cf4650881398c633a236fd,
title = "Concentration of Costs Among High Utilizers of Health Care Services Over the First 10 Years After Spinal Cord Injury Rehabilitation: A Population-based Study",
abstract = "Objective: The purpose of this study was to (1) categorize individuals into high, medium, and low utilizers of health care services over a 10-year period after the onset of spinal cord injury (SCI) and (2) identify the pattern of causes of hospitalizations and the characteristics associated with high utilization. Design: Retrospective analysis of self-report assessment linked to administrative data. Setting: Data were collected from participants living in and utilizing hospitals in the state of South Carolina. Participants: Adult participants with traumatic SCI were identified through a state SCI Surveillance System Registry, a population-based system capturing all incident cases treated in nonfederal facilities. Among 963 participants who completed self-report assessments, we matched those with a minimum of 10 years of administrative records for a final sample of 303 participants (N=303). Interventions: Not applicable. Main Outcome Measures: Costs related to health care utilization for emergency department visits and hospitalizations, as measured operationally by hospital charges at full and established rates; causes of hospitalizations Results: Over two-thirds of the total $49.4 million in charges for hospitalization over the 10-year timeframe (69{\%}) occurred among 16.5{\%} of the cohort (high utilizers), whereas those in the low utilizer group comprised 53{\%} of the cohort with only 3.5{\%} of the charges. The primary diagnoses were septicemia (50{\%}), other urinary tract disorder (48{\%}), mechanical complication of device, implant, or graft (48{\%}), and chronic ulcer of skin (40{\%}). Primary diagnoses were frequently accompanied by secondary diagnoses, indicating the co-occurrence of multiple secondary health conditions. High utilizers were more likely to be male, minority, have a severe SCI, have reported frequent pressure ulcers and have income of less than $35,000 per year. Conclusions: The high cost of chronic health care utilization over a 10-year timeframe was concentrated in a relatively small portion of the SCI population who have survived more than a decade after SCI onset.",
keywords = "Health care costs, Hospitalization, Rehabilitation, Spinal cord injuries",
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T1 - Concentration of Costs Among High Utilizers of Health Care Services Over the First 10 Years After Spinal Cord Injury Rehabilitation

T2 - A Population-based Study

AU - Krause, James S.

AU - Murday, David

AU - Corley, Elizabeth

AU - DiPiro, Nicole D.

PY - 2019/1/1

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N2 - Objective: The purpose of this study was to (1) categorize individuals into high, medium, and low utilizers of health care services over a 10-year period after the onset of spinal cord injury (SCI) and (2) identify the pattern of causes of hospitalizations and the characteristics associated with high utilization. Design: Retrospective analysis of self-report assessment linked to administrative data. Setting: Data were collected from participants living in and utilizing hospitals in the state of South Carolina. Participants: Adult participants with traumatic SCI were identified through a state SCI Surveillance System Registry, a population-based system capturing all incident cases treated in nonfederal facilities. Among 963 participants who completed self-report assessments, we matched those with a minimum of 10 years of administrative records for a final sample of 303 participants (N=303). Interventions: Not applicable. Main Outcome Measures: Costs related to health care utilization for emergency department visits and hospitalizations, as measured operationally by hospital charges at full and established rates; causes of hospitalizations Results: Over two-thirds of the total $49.4 million in charges for hospitalization over the 10-year timeframe (69%) occurred among 16.5% of the cohort (high utilizers), whereas those in the low utilizer group comprised 53% of the cohort with only 3.5% of the charges. The primary diagnoses were septicemia (50%), other urinary tract disorder (48%), mechanical complication of device, implant, or graft (48%), and chronic ulcer of skin (40%). Primary diagnoses were frequently accompanied by secondary diagnoses, indicating the co-occurrence of multiple secondary health conditions. High utilizers were more likely to be male, minority, have a severe SCI, have reported frequent pressure ulcers and have income of less than $35,000 per year. Conclusions: The high cost of chronic health care utilization over a 10-year timeframe was concentrated in a relatively small portion of the SCI population who have survived more than a decade after SCI onset.

AB - Objective: The purpose of this study was to (1) categorize individuals into high, medium, and low utilizers of health care services over a 10-year period after the onset of spinal cord injury (SCI) and (2) identify the pattern of causes of hospitalizations and the characteristics associated with high utilization. Design: Retrospective analysis of self-report assessment linked to administrative data. Setting: Data were collected from participants living in and utilizing hospitals in the state of South Carolina. Participants: Adult participants with traumatic SCI were identified through a state SCI Surveillance System Registry, a population-based system capturing all incident cases treated in nonfederal facilities. Among 963 participants who completed self-report assessments, we matched those with a minimum of 10 years of administrative records for a final sample of 303 participants (N=303). Interventions: Not applicable. Main Outcome Measures: Costs related to health care utilization for emergency department visits and hospitalizations, as measured operationally by hospital charges at full and established rates; causes of hospitalizations Results: Over two-thirds of the total $49.4 million in charges for hospitalization over the 10-year timeframe (69%) occurred among 16.5% of the cohort (high utilizers), whereas those in the low utilizer group comprised 53% of the cohort with only 3.5% of the charges. The primary diagnoses were septicemia (50%), other urinary tract disorder (48%), mechanical complication of device, implant, or graft (48%), and chronic ulcer of skin (40%). Primary diagnoses were frequently accompanied by secondary diagnoses, indicating the co-occurrence of multiple secondary health conditions. High utilizers were more likely to be male, minority, have a severe SCI, have reported frequent pressure ulcers and have income of less than $35,000 per year. Conclusions: The high cost of chronic health care utilization over a 10-year timeframe was concentrated in a relatively small portion of the SCI population who have survived more than a decade after SCI onset.

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KW - Rehabilitation

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