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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

National Meeting 2008

3021 — Healthcare Costs for Patients with Chronic Spinal Cord Injury in the Veterans

French DD (VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC), Campbell RR (VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC), Sabharwal S (SCI Service, VA Boston Healthcare System; Dept of PM&R, Harvard Medical School ), Nelson AL (VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC), Palacios PA (VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC), Gavin-Dreschnack D (VISN-8 Patient Safety Center of Inquiry, James A. Haley VAMC)

Recurring annual cost of caring for patients with chronic spinal cord injury (SCI) is a large economic burden on healthcare systems, but information on cost of SCI care beyond the acute and initial post-acute phase is sparse. Establish a frame of reference and estimate of the annual direct medical costs associated with healthcare for a sample of patients with chronic SCI (i.e., > 2 years post-injury).

Patients were recruited from three Veterans Health Administration (VHA) SCI facilities; baseline patient information was cross referenced to the Decision Support System (DSS) National Data Extracts (NDE) to obtain patient-specific healthcare cost in VHA. Descriptive statistical analysis of annual DSS-NDE cost of SCI patients (N=675) for fiscal year (FY) 2005 by level and completeness of injury was conducted.

Total (inpatient and outpatient) annual (FY 2005) direct medical costs for 675 SCI patients exceeded $14.47 million or $21,450 per patient. Average annual total costs varied from $28,334 for cervical complete SCI to $16,792 for thoracic incomplete SCI. 233 of the 675 SCI patients who were hospitalized over the study period account for a total of 378 hospital discharges costing in excess of $7.19 million. This approximated cost of outpatient care received ($7.28 million) for our entire sample.

The comprehensive nature of healthcare delivery and related cost capture for people with chronic SCI in VHA provided us the opportunity to accurately determine healthcare costs for this population. Future SCI post-acute care cost analyses should consider case-mix adjusting patients at high risk for rehospitalization.

Research on the long-term costs of care for disabling injuries is important because it provides an empirical basis for policy makers to allocate resources, identifies important secondary conditions associated with the injury, and identifies particularly vulnerable sub-populations that are impacted.

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