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Characteristics of adults with incident traumatic spinal cord injury in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature150135
Source
Spinal Cord. 2010 Jan;48(1):39-44
Publication Type
Article
Date
Jan-2010
Author
C M Couris
S J T Guilcher
S E P Munce
K. Fung
B C Craven
M. Verrier
S B Jaglal
Author Affiliation
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
Source
Spinal Cord. 2010 Jan;48(1):39-44
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Female
Humans
Incidence
Male
Middle Aged
Ontario - epidemiology
Reference Values
Retrospective Studies
Risk factors
Sex Factors
Spinal Cord Injuries - epidemiology - etiology - mortality
Young Adult
Abstract
Cohort study.
To provide recent estimates of the incidence of traumatic spinal cord injury (SCI) in adults living in Ontario.
Ontario, Canada.
The study included all men and women aged 18 years and older living in Ontario. The two primary data sources used for this study were the census data provided by Statistics Canada and the hospital Discharge Abstract Database (DAD) provided by the Canadian Institute for Health Information. Incidence was estimated for the fiscal years 2003/04-2006/07, and examined by age, gender, mechanism and seasonality of injury, the level of injury, the presence of comorbidity and in-hospital mortality.
The incident cases had a mean age of 51.3 years (s.d. 20.1). The majority of the cases was male (74.1%) and had a cervical SCI caused by falls (49.5%). The age-adjusted incidence rate was stable over the 4-year study period, from 24.2 per million (95% CI: 21.2-27.6) in 2003 to 23.1 per million (95% CI: 20.2-26.3) in 2006.
Despite worldwide trends that have indicated motor vehicle collisions (MVCs) as the leading cause of injury, falls emerged as the leading cause of traumatic SCI in this study. This finding, and the fact that the number of fall-induced injuries increased steadily with age, may indicate that there is growing concern for the consequences of falls in the elderly. Further work is needed to understand this trend in age and gender and the causes of falls to develop effective fall prevention strategies.
PubMed ID
19546873 View in PubMed
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Direct costs of adult traumatic spinal cord injury in Ontario.

https://arctichealth.org/en/permalink/ahliterature122585
Source
Spinal Cord. 2013 Jan;51(1):64-9
Publication Type
Article
Date
Jan-2013
Author
S E P Munce
W P Wodchis
S J T Guilcher
C M Couris
M. Verrier
K. Fung
B C Craven
S B Jaglal
Author Affiliation
Department of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Source
Spinal Cord. 2013 Jan;51(1):64-9
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Ambulatory Care - economics
Community Health Services - economics
Costs and Cost Analysis
Databases, Factual
Female
Hospitalization - economics
Humans
Male
Middle Aged
Ontario
Outpatients
Patient Care - economics
Rehabilitation Centers - economics
Sex Factors
Socioeconomic Factors
Spinal Cord Injuries - economics - etiology - rehabilitation
Wounds and Injuries - complications - economics
Abstract
Retrospective economic analysis.
To determine the total direct costs of publicly funded health care utilization for the three fiscal years 2003/04 to 2005/06 (1 April 2003 to 31 March 2004 to 1 April 2005 to 31 March 2006), from the time of initial hospitalization to 1 year after initial acute discharge among individuals with traumatic spinal cord injury (SCI).
Ontario, Canada.
Health system costs were calculated for 559 individuals with traumatic SCI (C1-T12 AIS A-D) for acute inpatient, emergency department, inpatient rehabilitation (that is, short-stay inpatient rehabilitation), complex continuing care (CCC) (i.e., long-stay inpatient rehabilitation), home care services, and physician visits in the year after index hospitalization. All care costs were calculated from the government payer's perspective, the Ontario Ministry of Health and Long-Term Care.
Total direct costs of health care utilization in this traumatic SCI population (including the acute care costs of the index event and inpatient readmission in the following year after the index discharge) were substantial: $102?900 per person in 2003/04, $100?476 in 2004/05 and $123?674 in 2005/06 Canadian Dollars (2005 CDN $). The largest cost driver to the health care system was inpatient rehabilitation care. From 2003/04 to 2005/06, the average per person cost of rehabilitation was approximately three times the average per person costs of inpatient acute care.
The high costs and long length of stay in inpatient rehabilitation are important system cost drivers, emphasizing the need to evaluate treatment efficacy and subsequent health outcomes in the inpatient rehabilitation setting.
PubMed ID
22801189 View in PubMed
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Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study.

https://arctichealth.org/en/permalink/ahliterature150134
Source
Spinal Cord. 2010 Jan;48(1):45-50
Publication Type
Article
Date
Jan-2010
Author
S J T Guilcher
S E P Munce
C M Couris
K. Fung
B C Craven
M. Verrier
S B Jaglal
Author Affiliation
Department of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Source
Spinal Cord. 2010 Jan;48(1):45-50
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cohort Studies
Community Health Planning
Delivery of Health Care - utilization
Female
Hospital Mortality
Humans
Insurance, Health - statistics & numerical data
Length of Stay
Logistic Models
Male
Middle Aged
Morbidity
Ontario - epidemiology
Paraplegia - rehabilitation
Rehabilitation Centers
Retrospective Studies
Severity of Illness Index
Socioeconomic Factors
Spinal Cord Injuries - classification - epidemiology - rehabilitation
Statistics, nonparametric
Abstract
Retrospective cohort design.
To compare socio-demographic, impairment characteristics and utilization (physician and emergency department (ED) visits) for non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury 1 year post inpatient rehabilitation.
Ontario, Canada.
Inpatient stays (2003-2006) were identified from the National Rehabilitation Registry System. Exclusions were: in-hospital mortality; discharge after 31 March 2006; death within 1 year after discharge. Multivariate logistic regression analyses were used to determine factors predicting high utilization.
NTSCI cases (n=1002) were greater than TSCI (n=560). NTSCIs were older (mean=61.6, s.d.=15.8) with more co-morbidities, paraplegic (39.5%) and female (P
PubMed ID
19546877 View in PubMed
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Health system factors associated with rehospitalizations after traumatic spinal cord injury: a population-based study.

https://arctichealth.org/en/permalink/ahliterature152151
Source
Spinal Cord. 2009 Aug;47(8):604-9
Publication Type
Article
Date
Aug-2009
Author
S B Jaglal
S E P Munce
S J Guilcher
C M Couris
K. Fung
B C Craven
M. Verrier
Author Affiliation
Department of Physical Therapy, University of Toronto, Ontario, Canada. susan.jaglal@utoronto.ca
Source
Spinal Cord. 2009 Aug;47(8):604-9
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Age Factors
Cohort Studies
Female
Humans
Length of Stay - statistics & numerical data
Male
Middle Aged
Ontario
Patient Readmission - statistics & numerical data
Rural Population
Spinal Cord Injuries - complications
Abstract
This is a cohort study with 1-year follow-up.
The aim of this study was to examine 1-year rehospitalization rates following spinal cord injury (SCI) onset and health system factors affecting rehospitalization.
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.
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.
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.
PubMed ID
19274059 View in PubMed
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Is the emergency department an appropriate substitute for primary care for persons with traumatic spinal cord injury?

https://arctichealth.org/en/permalink/ahliterature119037
Source
Spinal Cord. 2013 Mar;51(3):202-8
Publication Type
Article
Date
Mar-2013
Author
S J T Guilcher
B C Craven
A. Calzavara
M A McColl
S B Jaglal
Author Affiliation
Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. sara.guilcher@utoronto.ca
Source
Spinal Cord. 2013 Mar;51(3):202-8
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cohort Studies
Emergency Medical Services - trends - utilization
Emergency Service, Hospital - trends - utilization
Female
Humans
Male
Middle Aged
Ontario - epidemiology
Primary Health Care - trends - utilization
Retrospective Studies
Spinal Cord Injuries - diagnosis - epidemiology - therapy
Abstract
Retrospective cohort with linkage of administrative data sets.
To describe the patterns (for example, number of visits by year post-injury) and characteristics of the emergency department (ED) visits (for example, acuity level, timing of visits, reasons for visits) made by persons with traumatic spinal cord injury (TSCI) over a 6-year period following injury.
Ontario, Canada.
Rates of ED utilization and reasons for ED visits were calculated between the fiscal years 2003-2009. Reasons for visits were categorized by acuity level: potentially preventable visits were defined as visits related to ambulatory sensitive conditions; low acuity and high acuity visits were defined by the Canadian Triage and Acuity Scale.
The total number of ED visits for the 6-year period is 4403 (n=1217). Of these visits, 752 (17%) were classified as potentially preventable, 1443 (33%) as low acuity and 2208 (50%) as high acuity. The majority of patients, regardless of acuity level, did not see a primary care practitioner on the day of the ED visit and most visits occurred during the weekday (Mon-Fri 0700-1659 hours). ED use was highest in the first year but remained high over the subsequent years. For potentially preventable visits, the majority of visits were related to urinary tract infections (n=385 visits, 51.2%), followed by pneumonia (n=91, 12.1%).
Given the high rates of ED use for low acuity and potentially preventable conditions, these results suggest that the ED is being used as an inappropriate substitute for primary care for individuals with TSCI 50% of the time.
PubMed ID
23147131 View in PubMed
Less detail

Physician utilization among adults with traumatic spinal cord injury in Ontario: a population-based study.

https://arctichealth.org/en/permalink/ahliterature153067
Source
Spinal Cord. 2009 Jun;47(6):470-6
Publication Type
Article
Date
Jun-2009
Author
S E P Munce
S J T Guilcher
C M Couris
K. Fung
B C Craven
M. Verrier
S B Jaglal
Author Affiliation
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
Source
Spinal Cord. 2009 Jun;47(6):470-6
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Cohort Studies
Community Health Planning
Confidence Intervals
Emergency Service, Hospital - utilization
Female
Humans
Insurance, Health - statistics & numerical data
Male
Middle Aged
Odds Ratio
Ontario
Physicians, Family - utilization
Retrospective Studies
Spinal Cord Injuries - therapy
Young Adult
Abstract
Retrospective cohort study.
To describe the physician utilization patterns (family physicians (FP), specialist and emergency department (ED) visits) of adults with traumatic spinal cord injury (SCI) 1 year after the initial injury.
Ontario, Canada.
A total of 559 individuals with a traumatic SCI were identified. Five administrative databases were linked to examine health-care utilization in acute care, inpatient rehabilitation, chronic care rehabilitation, outpatient physician visits and ED visits. Factors predicting frequent physician, specialist and ED use were identified.
The mean number of physician visits for traumatic SCI patients during the first year after their injury onset was 31.7 (median 26). FPs had the greatest number of visits (mean 11.6, median 7) followed by physiatrists (mean 6.1, median 2). Factors predicting 50 or more physician visits included age 70 or above (OR=3.6, 95% CI=2.0-6.5), direct discharge to chronic care (OR=3.6, 95% CI=1.0-13.1) and in-hospital complication (OR=2.34, 95% CI=1.3-4.3). Age 70 or less (OR=0.19, 95% CI=0.0-0.9) and direct discharge to chronic care were associated with 50 or more specialist visits. Only rurality predicted two or more visits to the ED.
Individuals with traumatic SCI show significant physician utilization, especially among their FPs and physiatrists. Although the factors predicting higher physician and specialist utilization may reflect individuals with the most severe impairment, comorbid conditions or lack of social support, the model for higher ED visits may point to limited accessibility to/availability of primary care services for SCI patients in rural regions.
PubMed ID
19153588 View in PubMed
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6 records – page 1 of 1.