Decreasing re-hospitalizations and emergency department visits in persons with recent spinal cord injuries using a specialized medical home

Use of professional home care in persons with spinal cord injury in Switzerland: a cross-sectional study

BACKGROUND

Persons with spinal cord injury (SCI) living in the community often require care. The boundaries between professional home care and informal care are blurred, and it is unclear who the typical user of home care is. The objective of this study was to describe the characteristics of persons with SCI using professional home care in Switzerland, determine the frequency of home care visits, and investigate the association of sociodemographic factors, SCI-specific characteristics, secondary health conditions, and functional independence with the use of home care.

METHODS

We used cross-sectional data from the 2017 community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI). Out of 3,959 eligible individuals 1294 completed the questionnaire and were included in the analysis (response rate 33%). Using descriptive statistics, differences between home care users and non-users as well as the frequency of home care visits were investigated. The association between sociodemographic factors, SCI-specific characteristics, secondary health conditions, functional independence and the use of home care was analyzed using multivariable logistic regression. Multiple imputation was used to account for missing data.

RESULTS

Of 1,294 participants, 280 (22%) used professional home care. The median weekly professional home care duration was 6 h (Q1 = 2, Q3 = 12). More home care was used in persons with lower functional independence (Odds ratio (OR) 0.30 per 10 unit decrease in the Spinal Cord Independence Measure, 95%-Confidence interval (CI) 0.24-0.37), fewer secondary health conditions (OR 0.96 per unit Spinal Cord Injury Secondary Conditions Scale, 95%-CI 0.94-0.99), tetraplegia (OR 2.77, 95%-CI 1.92-4.00), women (OR 2.42, 95%-CI 1.70-3.43), higher age (OR 1.22 per 10 years increase, 95%-CI 1.06-1.39), living alone (OR 2.48, 95%-CI 1.53-4.03), and those receiving support from an informal caregiver (OR 1.88, 95%-CI 1.27-2.77).

CONCLUSIONS

This is the first study to examine the use of professional home care from the perspective of persons with SCI in Switzerland. Lower functional independence strongly predicts increased home care use. The findings showed that professional home care complements informal care and is more likely to be used by individuals with SCI who live alone, have tetraplegia, and are female.

Exploring caregivers' perceptions of community-based service requirements of patients with spinal cord injury: a qualitative study

BACKGROUND

The incidence of spinal cord injury is increasing worldwide. Patients with spinal cord injury and their families face many difficulties during the disease course. Caregivers are more involved with these patients than anyone else, so recognizing patients' care requirements based on caregivers' opinions can facilitate care provision to these people. The purpose of this study was to explore caregivers' perceptions of the community-based services requirements of patients with spinal cord injury.

METHODS

This qualitative research was conducted in Iran from Apr 2021 to Dec 2022 using the conventional content analysis method. The participants in the study included family caregivers and providers of home care services to patients with spinal cord injury, who were selected by purposeful sampling. Data were collected by conducting 14 face-to-face interviews and analyzed based on the method proposed by Lundman and Graneheim.

RESULTS

Data analysis led to the extraction of 815 primary codes, which were organized into two themes: community reintegration (with two categories, including the need to provide a suitable social platform and lifelong care) and palliative care (with two categories, including family conference and survival management).

CONCLUSION

Social facilities and infrastructure should be modified in a way that patients with spinal cord injury can appropriately benefit from community-based care services and an independent satisfactory life. Palliative care should be continuously provided from the time of lesion development until the patient's death.

The Relationship of Secondary and Chronic Health Conditions With Emergency Department Visits and Related Hospitalizations Among People With Traumatic Spinal Cord Injury

OBJECTIVE

Identify the relationship of health conditions with self-reported emergency department (ED) visits and ED-related hospitalizations among people with traumatic spinal cord injury (SCI), while controlling for demographic, injury, and socioeconomic factors.

DESIGN

Cross-sectional.

SETTING

A regional SCI model system in the Southeastern United States.

PARTICIPANTS

Participants (N=648) were adults with chronic traumatic SCI at least 1 year postinjury who were identified through their Form II annual follow-up within the SCI Model Systems.

INTERVENTIONS

N/A.

MAIN OUTCOME MEASURES

Self-reported ED visits and ED-related hospitalizations within the 12 months prior to the study.

RESULTS

Several types of factors were significantly related to ED visits, with fewer related to ED hospitalizations. Men (odds ratio [OR]=1.58); those divorced, widowed, or separated (OR=1.57); and those with more severe SCI (C1-C4, or American Spinal Injury Association Impairment Scale A/B) had greater odds of having at least 1 ED visit; education and employment factors were not significant. Of health conditions, acute secondary health conditions including falls (OR=1.45), urinary tract infections (UTIs; OR=2.40), and pressure injuries (OR=1.58) were all associated with a greater odds of ED visits, whereas chronic health conditions were not. Being unemployed was associated with greater odds of an ED hospitalization (OR=1.79), as was having at least 1 UTI (OR=2.24) and at least 1 pressure injury (OR=2.37).

CONCLUSIONS

The current findings suggest acute secondary health conditions, particularly UTIs and pressure injuries, were much more highly related to ED visits and related hospitalizations compared to chronic health conditions (eg, diabetes, hypertension). Greater attention needs to be paid to fall, UTI, and pressure injury prevention to reduce the ED burden related to SCI.

The relationship between health behaviors and emergency department visits and hospitalizations after traumatic spinal cord injury

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To identify demographic, injury, and behavioral predictors of emergency department (ED) visits and ED-related hospitalizations among individuals with chronic traumatic spinal cord injury (SCI).

SETTING

An academic medical center in the Southeastern United States.

METHODS

4057 participants who were at least 18 years of age and 1 year post traumatic SCI with residual neurologic impairment were identified from three cohorts: a rehabilitation specialty hospital in the Southeastern USA and two SCI Surveillance System Registries, one in the Midwestern and one in the Southeastern USA. The participants completed a self-reported assessment on ED visits and ED hospitalizations (yes/no) in the past 12 months. Logistic regression models were used to examine the relationship between ED visits/hospitalizations and eight behavioral indicators, including body weight, healthy diet, drinking, smoking, non-medical substance usage, prescription medication usage, prescription medication misuse, and the planned exercise.

RESULTS

During the study period, 41% of participants reported having at least one ED visit and 21% participants reported hospitalization after ED visit in the past 12 months. High frequency of prescription medication usage, prescription medication misuse, and lack of planned exercise were associated with greater odds of at least one ED visit and at least one ED-related hospitalization, while smoking was only associated with ED visits.

CONCLUSIONS

Health care professionals should be aware that ED visit and related hospitalization prevalence remain high among people with chronic SCI, and there is significant need for intervention of managing risk behaviors and promoting healthy behaviors after SCI.

Timing and pattern of readmission in individuals with spinal cord injury in the setting of a specialized medical home

BACKGROUND

The rate of readmission in individuals with spinal cord injury (SCI) is known to be high (28% to 45%) during the first year post-injury and post-rehabilitation. However, there are several critical gaps in our knowledge including the timing pattern of medical complications and the pattern of health complications associated with readmissions.

OBJECTIVE

To identify the timing and pattern of complications associated with hospital readmissions in individuals with traumatic SCI and non-traumatic spinal cord disorders (SCI) post-discharge from an inpatient rehabilitation facility (IRF).

DESIGN

Secondary analysis of a three year prospective cohort study.

SETTING

An SCI medical home.

PARTICIPANTS

Individuals who were readmitted (n = 53) within the first year (N = 176) post-discharge from an IRF.

INTERVENTIONS

N/A.

OUTCOME MEASURES

Timing and pattern of all-cause hospital readmissions.

RESULTS

Eighty one percent of the readmitted patients experienced readmission within the first six months after discharge, and 36% of the initial readmissions occurred within 30 days of discharge from an IRF. The trend line for the timing of the first readmission post-discharge from an IRF was curvilinear, with a sharp decrease in the number of new patients readmitted for months 1-7 and then a slight increase between 9 and 12 months. Urological and respiratory complications were related to repeat readmissions.

CONCLUSION

The patient is at the greatest risk of readmission in the first 6 months, with a secondary increase in risk at 9 months. Possible reasons may include reduction in in-home and outpatient therapy and skilled nursing over the first year post-SCI.

A Systematic Review of the Effects of Community Transition Programs on Quality of Life and Hospital Readmissions for Adults With Traumatic Spinal Cord Injury

OBJECTIVE

To investigate the effects of community transition programs for adults with traumatic spinal cord injury (tSCI) on hospital readmissions and quality of life (QOL).

DATA SOURCES

Seven databases (PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Google Scholar, the Joanna Briggs Institute database, OTseeker, and PEDro) and reference lists of relevant articles were searched from inception through March 2020.

STUDY SELECTION

Original research studies were included that (1) evaluated interventions designed to support individuals aged 18-65 years with newly acquired tSCI in navigating the transition from subacute care to the community and (2) reported data for QOL or hospital readmission outcomes. Searches identified 4694 studies, and 26 of these met the selection criteria.

DATA EXTRACTION

Two reviewers independently screened and assessed all studies, extracting information about study type, methodological strengths and weaknesses, participant and intervention characteristics, comparator, and significant results. Any discrepancies were resolved by a third reviewer.

DATA SYNTHESIS

Studies were grouped according to primary intervention: peer mentoring (n=8), telehealth (n=5), education (n=5), independent living (n=3), occupational therapy (n=1), counseling (n=1), and patient navigation (n=4). Reviewers used the Let Evidence Guide Every Decision appraisal tool rubric to grade the body of evidence for each intervention type. Moderate level evidence supports the positive effects of peer mentoring, and low level evidence indicates positive effects of telehealth, education, independent living, and occupational therapy interventions. Peer mentoring, telehealth, and patient navigation were the only intervention types that included hospital readmission outcomes. Of these, peer mentoring had the most evidence, with 3 of the 4 studies that included hospital readmission outcomes demonstrating statistically significant improvements.

CONCLUSIONS

In general, there is a paucity of high-quality evidence with sufficiently similar characteristics to demonstrate and compare benefits from program participation. When high quality studies have been conducted, they have obtained mixed results. Of the different intervention types, peer mentorship has the strongest supporting evidence. Further research is needed to identify specific intervention components that are most effective in improving QOL and reducing hospital readmission for specific subgroups of individuals recovering from tSCI.

Models of Care Delivery from Rehabilitation to Community for Spinal Cord Injury: A Scoping Review

Spinal cord injury (SCI) is a chronic condition that results in high healthcare utilization and lifetime cost across the care continuum. In the absence of a standardized model of care delivery for SCI in western countries such as Canada, a scoping review of the literature was performed to identify and summarize existing international SCI models of care delivery. Four databases were searched using key words and subject headings for concepts such as: "spinal cord injury," "delivery of healthcare," "model of care," "patient care planning," and "care pathway." Title, abstract, and full text review were competed by two independent reviewers. A combined total of 46 peer-reviewed and gray literature articles were included. No single SCI model of care has been adopted across different countries internationally. However, optimal attributes of models of care were identified, including the importance of having multidisciplinary SCI specialty care providers along the continuum, provision of rural SCI services and outreach, integration of primary care, peer mentoring, and using a hub and spokes model of care. These findings inform the future development of an SCI model of care, which ideally would serve all geographical locations and span the continuum of care, improving the health status and quality of life of persons with SCI.