Timing and pattern of readmission in individuals with spinal cord injury in the setting of a specialized medical home.

BACKGROUND

The rate of readmission in individuals with spinal cord injury (SCI) is known to be high (28% to 45%) during the first year post-injury and post-rehabilitation. However, there are several critical gaps in our knowledge including the timing pattern of medical complications and the pattern of health complications associated with readmissions.

OBJECTIVE

To identify the timing and pattern of complications associated with hospital readmissions in individuals with traumatic SCI and non-traumatic spinal cord disorders (SCI) post-discharge from an inpatient rehabilitation facility (IRF).

DESIGN

Secondary analysis of a three year prospective cohort study.

SETTING

An SCI medical home.

PARTICIPANTS

Individuals who were readmitted ( = 53) within the first year ( = 176) post-discharge from an IRF.

INTERVENTIONS

N/A.

OUTCOME MEASURES

Timing and pattern of all-cause hospital readmissions.

RESULTS

Eighty one percent of the readmitted patients experienced readmission within the first six months after discharge, and 36% of the initial readmissions occurred within 30 days of discharge from an IRF. The trend line for the timing of the first readmission post-discharge from an IRF was curvilinear, with a sharp decrease in the number of new patients readmitted for months 1-7 and then a slight increase between 9 and 12 months. Urological and respiratory complications were related to repeat readmissions.

CONCLUSION

The patient is at the greatest risk of readmission in the first 6 months, with a secondary increase in risk at 9 months. Possible reasons may include reduction in in-home and outpatient therapy and skilled nursing over the first year post-SCI.