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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3097 — Cost of Treating Pressure Ulcers for Veterans with Spinal Cord Injury

Stroupe KT (Center for Management of Complex Chronic Care, Hines VA Hospital), Manheim L (Northwestern University), Evans CT (Center for Management of Complex Chronic Care, Hines VA Hospital), Guihan M (Center for Management of Complex Chronic Care, Hines VA Hospital), Ho C (Louis Stokes Cleveland Department of Veterans Affairs Medical Center), Li K (Center for Management of Complex Chronic Care, Hines VA Hospital), Cowper-Ripley D (RR&D/HSR&D Rehabilitation Outcomes Research Center Research Enhancement Award Program), Hogan TP (Center for Management of Complex Chronic Care, Hines VA Hospital), St.Andre JR (Center for Management of Complex Chronic Care, Hines VA Hospital), Smith BM (Center for Management of Complex Chronic Care, Hines VA Hospital)

Objectives:
There are approximately 250,000 persons with spinal cord injury/disorder (SCI/D) in the US, and Veterans comprise almost 17% of this population. Pressure ulcers (PUs) are common, serious complications frequently resulting in hospitalization in this population. This study examined annual healthcare utilization and costs of treating Veterans in this population with PUs in VA.

Methods:
We conducted retrospective analyses of Veterans with SCI/D who received care at VA healthcare facilities. We identified Veterans with and without an incident PU diagnosis in FY07. To ensure the FY07 PU diagnoses were incident, we excluded patients with PU diagnoses in FY06. We compared healthcare utilization and costs (using Decision Support System [DSS] data) during the 12-month period following the date of the first PU diagnosis in FY07 with utilization and costs in FY08 for patients without PUs using bivariate and multiple regression analyses. Costs were adjusted to 2008 dollars using the Consumer Price Index.

Results:
Of the 10,977 patients meeting our inclusion criteria, 11% had an incident PU in FY07. After adjusting for patient characteristics, patients with PUs averaged nearly 52 more total inpatient days than patients without PUs during a 12-month period (61.00 vs. 9.19; P < 0.001), which was due primarily to more days in SCI/D care units (39.16 vs. 3.28; P < 0.05) and in long-term care (15.83 vs. 5.24; P < 0.05). After adjusting for patient characteristics, total healthcare costs were $73,021 higher for patients with PUs ($100,935 vs. $27,914; P < 0.001), which was due primarily to higher total inpatient costs ($91,341 vs. $13,754; P < 0.05).

Implications:
PUs result in protracted hospitalizations and higher costs, representing over $89 million in total additional costs to the healthcare system.

Impacts:
The high cost of PUs to the healthcare system warrant further interventions, which may include promotion of early detection and treatment of minor skin problems that have not yet developed into PUs. If interventions to prevent PUs could be developed that cost approximately $8,000 or less per patient to implement (i.e., $89 million/10,997), these interventions might ultimately be cost saving to VA. Such interventions might lessen the burden of illness for patients as well as costs to the healthcare system due to PUs.


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