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A Comparison of Costs and Health Care Utilization for Veterans with Traumatic and Nontraumatic Spinal Cord Injury

St. Andre JR, Smith BM, Stroupe KT, Burns SP, Evans CT, Cowper Ripley DC, Li K, Huo Z, Hogan TP, Weaver FM. A Comparison of Costs and Health Care Utilization for Veterans with Traumatic and Nontraumatic Spinal Cord Injury. Topics in spinal cord injury rehabilitation. 2011 Mar 1; 16(4):27-42.

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Approximately one quarter of a million individuals live with a serious spinal cord injury/disorder (SCI/D) in the United States. Of this number, over 42,000, or approximately 17%, are veterans of the US Armed Forces. It is estimated that Veterans Healthcare Administration (VHA) offered comprehensive care to roughly 26,000 veterans with SCI/D in 2008. The VHA provides comprehensive, lifelong services to veterans with traumatic and nontraumatic injuries, including primary and specialty care, rehabilitation, and long-term care. The most frequent causes of traumatic injuries include automobile accidents, motorcycle accidents, falls, sports injuries, and gunshot wounds. Common nontraumatic etiologies include spondylosis and spinal stenosis, infection, tumor, syringomyelia, and vascular disorders. The proportion of nontraumatic to traumatic injuries may be increasing as a result of the increased aging population. Previous studies have reported utilization and associated costs for traumatic SCI2; however, utilization and cost involving nontraumatic SCI is poorly documented. Treatment of SCI/D in the first year of injury has been shown to differ by injury onset (traumatic vs nontraumatic) as reflected by differences in utilization patterns, such as higher number of internist and neurosurgeon visits for individuals with nontraumatic injuries compared to traumatic causes. Persons with traumatic injury have higher numbers of visits to urologists and physiatrists compared to individuals with nontraumatic injuries. Although a few studies have compared traumatic and nontraumatic SCI/D and health care utilization, associated costs were not examined. Understanding health care utilization and associated costs of veterans with SCI/D will provide information that is vital to the VA's mission of providing high-quality and efficient health care to veterans. This information is crucial for clinicians, planners, and policymakers. The objectives of this study were to compare demographic characteristics, utilization patterns, and health care costs, including hospital length of stay and pharmacy use, in a single year for veterans with traumatic and nontraumatic etiologies.

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