Health system factors associated with rehospitalizations after traumatic spinal cord injury: a population-based study

Study design: This is a cohort study with 1-year follow-up. Objectives: The aim of this study was to examine 1-year rehospitalization rates following spinal cord injury (SCI) onset and health system factors affecting rehospitalization. Methods: All persons who had an acute care hospitalization for traumatic SCI in Ontario between 1 April 2003 and 31 March 2006 were identified according to International Classification of Diseases, Tenth Revision codes and followed for 1 year following acute care discharge through record linkage of administrative databases. Index cases with an SCI admission the year before 2003 as well as persons who died within 1 year after the index hospitalization were excluded from the analysis. Factors associated with 1-year rehospitalization were assessed using multivariate logistic regression analyses and included age, sex, rurality, length of stay, comorbidity, level of injury, discharge disposition, in-hospital complication, physician visits and specialist visits measure and etiology of injury. Results: A total of 559 individuals met the inclusion criteria and 27.5% (n = 154) were rehospitalized 1 year after initial acute care discharge. Factors significantly associated with 1-year rehospitalization were length of stay, rural residence, 50+ outpatient physician visits and 50+ specialists visits following the index admission. The main causes of rehospitalization were musculoskeletal, respiratory, gastrointestinal and urological disorders. Conclusion: This study presents recent data on rehospitalization and yet rehospitalization rates continue to remain high. Our findings have significant implications for healthcare policy and planning in Ontario, Canada with respect to the management of SCI to achieve optimal health outcomes, in particular in rural areas. Spinal Cord (2009) 47, 604-609; doi: 10.1038/sc.2009.9; published online 10 March 2009