Health Care Utilization in Veterans With Tetraplegia in the First Year After Cervical Spinal Cord Injury: Identifying Opportunities for Dissemination of Treatment Information.
Katharine Tam, Daniel Eaton, Amanda Mayo, Aimee James, Candace Tefertiller, Katherine C Stenson, Catherine Curtin, Doug Ota, Flora Laurent, Michael J Berger, Jana Dengler, Ida K Fox
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引用次数: 0
Abstract
Objective: To describe Veterans Affairs (VA) utilization patterns by Veterans with tetraplegia during the first year after cervical spinal cord injury (SCI) and explore differences among subpopulations. A secondary objective of this study was to develop a process map to guide targeted clinician education about upper limb treatment information.
Design: Retrospective cohort study using the Veterans Health Administration (VHA) Spinal Cord Injury and Disorders (SCI/D) Registry and the VHA Corporate Data Warehouse.
Setting: Outpatient setting in the VHA.
Participants: Veterans (N=884) with traumatic, C5-C8 neurologic level of injury, and American Spinal Injury Association Impairment Scale A-C classification who received care at a regional VA SCI/D Center between October 1, 2012, and September 30, 2019.
Interventions: Not applicable.
Main outcome measures: VA health care utilization as defined by ≥1 VA outpatient visit within the first year of SCI using VHA administrative data. We also examined predictors of care interactions using multivariate logistic regression models.
Results: In total, 489 Veterans (55%) had ≥1 VA outpatient visit in the first year after SCI whereas 395 Veterans (45%) did not receive outpatient VA care within their first year after SCI. Veterans who used VA health care received a median of 41 outpatient visits in the first year after SCI. Veterans had the highest median number of visits and shortest time interval from SCI to initial visit with therapists (physical, occupational, and recreational) compared to other health care providers. No significant predictors of care were identified with adjusted and unadjusted multivariate logistic regression.
Conclusions: Health care utilization patterns of Veterans with tetraplegia identified physical, occupational, and recreational therapists as the health care providers who had visits early and often with these Veterans. Therapists are uniquely positioned in health care systems to facilitate communication of treatment opportunities to persons with tetraplegia.
目的：了解四肢瘫痪退伍军人颈脊髓损伤（SCI）后第一年的退伍军人事务（VA）利用情况，并探讨亚群间的差异。本研究的第二个目的是制定一个过程图，以指导有针对性的临床医生对上肢（UL）治疗信息的教育。设计：回顾性队列研究，利用退伍军人健康管理局（VHA）脊髓损伤和疾病（SCI/D）登记处和VHA公司数据仓库（CDW）设置：VHA门诊设置参与者：884名创伤性、C5-C8神经损伤水平（NLI）和美国脊髓损伤协会（ASIA）损伤量表（AIS） a - c分类的退伍军人，他们在2012年10月1日至2019年9月30日期间在VA区域SCI/D中心接受治疗。干预措施：不适用主要结果测量：根据VHA管理数据，在脊髓损伤的第一年至少有一次VA门诊就诊来定义VA医疗保健利用。我们还使用多元逻辑回归模型检验了护理相互作用的预测因子。结果：489名退伍军人（55%）在脊髓损伤后的一年内至少进行过一次VA门诊治疗，而395名退伍军人（45%）在脊髓损伤后的一年内没有接受过VA门诊治疗。使用VA医疗保健的退伍军人在脊髓损伤后的第一年平均有41次门诊就诊。与其他医疗保健提供者（HCP）相比，退伍军人从脊髓损伤到初次就诊（物理、职业和娱乐）的中位数次数最高，间隔时间最短。经调整和未调整的多因素logistic回归均未发现显著的护理预测因子。结论：四肢瘫痪退伍军人的医疗保健利用模式确定了身体、职业和娱乐治疗师是早期和经常访问四肢瘫痪退伍军人的HCPs。治疗师在医疗保健系统中具有独特的地位，可以促进对四肢瘫痪患者的治疗机会的交流。
期刊介绍：
The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities.
Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.
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