Utilization and features of rehabilitation and health services for persons with spinal cord injury

BACKGROUND: The increasing prevalence of individuals experiencing disabilities underscores the importance of rehabilitation. Nevertheless, healthcare systems are already facing financial constraints, which makes it imperative to strive for a more efficient delivery of services. The first step, however, is to understand how the provision of services behaves for patients with different characteristics. AIM: To determine the most frequently used healthcare services in the (sub)acute phase of rehabilitation of patients with spinal cord injury/ disease (SCI/D) and the link with patient characteristics. DESIGN: Observational cohort study. POPULATION: This study analyzes the clinical data of patients discharged from a specialized SCI hospital and rehabilitation center in Switzerland. METHODS: We implemented a compound risk model to estimate the total amount of healthcare services used, defined by length of stay (LOS) and the units per day of health services (sub)acute phase of rehabilitation. RESULTS: The study included 403 individuals with SCI/D. The analysis of the intensity and severity of healthcare services across different patient and injury characteristics revealed differences in the intensity of healthcare use and variations in the length of stay (LOS). Male patients with a low SCIM upon admission tended to use healthcare services more extensively than female patients. In terms of etiology, therapies were employed more intensively for patients with traumatic SCI (TSCI). In addition, the analysis revealed that variations in the intensity of healthcare services used were more significant than those adjusted for LOS. Ultimately, similar patient groups received comparable quantities of healthcare services at the end of treatment. CONCLUSIONS: This population-based study provides information for a better understanding of the determinants of health service use during the (sub)acute rehabilitation phase of individuals with SCI/D. When analyzing LOS, intensity, and severity of services, it shows that the use of healthcare services significantly differs for the level of SCIM at admission, age groups, sex, and etiology. However, the variation among individual patients also suggests the presence of other infiuential modifiers that were not considered in this analysis. CLINICAL REHABILITATION IMPACT: The approach outlined enables a systematic follow-up of this data analysis by enriching the computed data with additional details about the patient, the patient's treatment, and outcomes.