Samsa G P, Landsman P B, Hamilton B
Center for Health Services Research in Primary Care, Durham, NC, USA.
Arch Phys Med Rehabil. 1996 Oct;77(10):1037-43. doi: 10.1016/s0003-9993(96)90065-9.
To describe the pattern of inpatient hospital utilization, up to 15 years after injury, among a cohort of veterans with service-connected traumatic spinal cord injury (SCI).
A cohort of 1,250 male veterans, with traumatic SCI occurring between 1970 and 1986, who visited the VA within 1 year of injury, was assembled from VA administrative files; diagnosis was verified by examining hospital discharge summaries.
Computerized record linkage among Department of Veterans Affairs (VA) administrative files was used to determine patterns of inpatient hospital utilization.
Pattern of inpatient admissions and length of stay (LOS).
Patients were typically white males injured in their mid-twenties. The initial VA hospitalization began approximately 6 weeks after injury and lasted 4 to 7 months, depending on injury level and completeness. Subsequent hospitalizations usually lasted approximately 10 days, but 22% of stays exceeded 1 months. Most hospitalizations took place in specialized SCI Centers. Comparing the 1980s with the 1970s, patients in the 1980s entered VA facilities sooner after injury, were more likely to visit SCI Centers, and had shorter initial stays. Rates for the incidence of rehospitalization decreased rapidly in years 2-5 after injury and declined less rapidly thereafter. Occupancy rates and proportion rehospitalized followed similar patterns. The incidence rate for persons with complete quadriplegia was approximately twice that of patients with incomplete paraplegia. Between 1970 and 1991, both the rehospitalization incidence rate and LOS decreased by approximately 20%. Only 10% of patients accounted for 46% of the total LOS. LOS during the first five years was predictive of later LOS.
The pattern of rehospitalization in VA facilities was generally consistent with that of the Model Systems. Efforts toward preventing rehospitalization should target persons with previous high utilization.
描述一组因服役相关创伤性脊髓损伤（SCI）退伍军人受伤后长达15年的住院利用模式。
从退伍军人事务部（VA）行政档案中选取了1250名男性退伍军人组成队列，他们在1970年至1986年间发生创伤性SCI，且在受伤后1年内就诊于VA；通过检查医院出院小结核实诊断。
利用退伍军人事务部（VA）行政档案之间的计算机化记录链接来确定住院利用模式。
住院入院模式和住院时间（LOS）。
患者通常为25岁左右受伤的白人男性。VA的首次住院在受伤后约6周开始，持续4至7个月，具体取决于损伤程度和完整性。随后的住院通常持续约10天，但22%的住院时间超过1个月。大多数住院发生在专门的SCI中心。将20世纪80年代与70年代进行比较，80年代的患者受伤后更快进入VA设施，更有可能就诊于SCI中心，且首次住院时间更短。受伤后第2至5年再住院发生率迅速下降，此后下降速度较慢。入住率和再住院比例遵循类似模式。完全性四肢瘫患者的发生率约为不完全性截瘫患者的两倍。1970年至1991年间，再住院发生率和住院时间均下降了约20%。仅10%的患者占总住院时间的46%。前五年的住院时间可预测后期住院时间。
VA设施中的再住院模式总体上与示范系统一致。预防再住院的努力应针对既往利用率高的人群。
