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

Abstract

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.