Study design

Longitudinal cohort study

Objective

To evaluate lifetime variation in healthcare utilization among individuals with a chronic spinal cord injury (SCI).

Setting

Medical university in the Southeastern United States (US).

Methods

Participants were identified from two Midwestern University hospitals and a specialty hospital in the Southeastern US and were enrolled in 1973–1974, 1984–1985, 1993–1994, and 2003–2004. Generalized linear mixed models were used to explore changes in nonroutine physician visits, hospitalizations, and days hospitalized within the 24 months prior to the study.

Results

Significant temporal linear spline change was found for nonroutine physician visits. The proportion of participants reporting ≥10 nonroutine physician visits in the 24 months prior to assessment kept relatively constant over the 30 years post injury (p value of trend: p = 0.605) and sharply increased afterwards (p_{knot = 30 years since injury} = 0.016). The trajectory for hospitalization and days hospitalized followed a quadratic pattern (p_{years post injury}² < 0.001) for all participants. The proportion of individuals who had at least one hospitalization and were hospitalized for more than 1 week significantly declined from the onset of SCI to 25–30 years post injury, then significantly increased thereafter.

Conclusions

The natural course of changes in three indices of healthcare utilization was curve-linearly, rather than linearly related to years post injury. People with SCI tended to have significant changes in healthcare utilization after about 30 years injury.

中文翻译：

---

非常规医生就诊和住院的趋势：脊髓损伤纵向老化研究的五个队列中的发现

学习规划

纵向队列研究

客观的

评估慢性脊髓损伤 (SCI) 患者在医疗保健利用方面的终生变化。

环境

美国东南部 (US) 的医科大学。

方法

参与者来自美国东南部的两家中西部大学医院和一家专科医院，并于 1973-1974 年、1984-1985 年、1993-1994 年和 2003-2004 年入组。广义线性混合模型用于探索研究前 24 个月内非常规就诊、住院和住院天数的变化。

结果

对于非常规医生就诊，发现了显着的时间线性样条变化。在评估前 24 个月内报告 ≥10 次非常规医生就诊的参与者比例在受伤后 30 年内保持相对稳定（趋势p值：p  = 0.605），之后急剧增加（p_{结 = 受伤后 30 年} = 0.016 ）。住院和住院天数的轨迹遵循二次模式（_受伤后p年² < 0.001) 对于所有参与者。从 SCI 发病到受伤后 25-30 年，至少住院 1 周且住院时间超过 1 周的个体比例显着下降，此后显着增加。

结论

三个医疗保健利用指数的自然变化过程是曲线线性的，而不是与受伤后的年数线性相关。SCI 患者在受伤约 30 年后往往在医疗保健利用方面发生显着变化。