Health Care Utilization in Veterans With Tetraplegia in the First Year After Cervical Spinal Cord Injury: Identifying Opportunities for Dissemination of Treatment Information.

OBJECTIVE

To describe Veterans Affairs (VA) utilization patterns by Veterans with tetraplegia during the first year after cervical spinal cord injury (SCI) and explore differences among subpopulations. A secondary objective of this study was to develop a process map to guide targeted clinician education about upper limb treatment information.

DESIGN

Retrospective cohort study using the Veterans Health Administration (VHA) Spinal Cord Injury and Disorders (SCI/D) Registry and the VHA Corporate Data Warehouse.

SETTING

Outpatient setting in the VHA.

PARTICIPANTS

Veterans (N=884) with traumatic, C5-C8 neurologic level of injury, and American Spinal Injury Association Impairment Scale A-C classification who received care at a regional VA SCI/D Center between October 1, 2012, and September 30, 2019.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

VA health care utilization as defined by ≥1 VA outpatient visit within the first year of SCI using VHA administrative data. We also examined predictors of care interactions using multivariate logistic regression models.

RESULTS

In total, 489 Veterans (55%) had ≥1 VA outpatient visit in the first year after SCI whereas 395 Veterans (45%) did not receive outpatient VA care within their first year after SCI. Veterans who used VA health care received a median of 41 outpatient visits in the first year after SCI. Veterans had the highest median number of visits and shortest time interval from SCI to initial visit with therapists (physical, occupational, and recreational) compared to other health care providers. No significant predictors of care were identified with adjusted and unadjusted multivariate logistic regression.

CONCLUSIONS

Health care utilization patterns of Veterans with tetraplegia identified physical, occupational, and recreational therapists as the health care providers who had visits early and often with these Veterans. Therapists are uniquely positioned in health care systems to facilitate communication of treatment opportunities to persons with tetraplegia.