OCCUPATIONAL SPINAL CORD OCCUPATIONAL SPINAL CORD INJURY INJURY EPIDEMIOLOGY AND COSTS EPIDEMIOLOGY AND COSTS Panagiotis V. Tsaklis, PhD Panagiotis V. Tsaklis, PhD Associate Professor Associate Professor Biomechanics – Tissue Mechanics Biomechanics – Tissue Mechanics School of Health Professions School of Health Professions Alexander TEI Thessaloniki Alexander TEI Thessaloniki ci. Massachussets Institute of Technology ci. Massachussets Institute of Technology t Mechanical Engineering t Mechanical Engineering sue & Polymers Lab sue & Polymers Lab bridge, MA, USA bridge, MA, USA
Panagiotis V. Tsaklis, PhDPanagiotis V. Tsaklis, PhDAssociate ProfessorAssociate ProfessorBiomechanics – Tissue MechanicsBiomechanics – Tissue MechanicsSchool of Health ProfessionsSchool of Health ProfessionsAlexander TEI ThessalonikiAlexander TEI Thessaloniki
V.Sci. Massachussets Institute of TechnologyV.Sci. Massachussets Institute of TechnologyDept Mechanical EngineeringDept Mechanical EngineeringTissue & Polymers LabTissue & Polymers LabCambridge, MA, USACambridge, MA, USA
The SPINAL CORD INJURY facts…The SPINAL CORD INJURY facts…
Spinal cord injury (SCI) is one of the Spinal cord injury (SCI) is one of the most severe injuries that can happen in most severe injuries that can happen in the workplace…the workplace…
……There is no cure for SCI, and a There is no cure for SCI, and a majority of cases does not improve majority of cases does not improve functionally even after rehabilitation…functionally even after rehabilitation…
SCI epidemiology and SCI epidemiology and economics…economics… The cost of SCI suggests that those with The cost of SCI suggests that those with
work-related tetraplegia receive a higher level work-related tetraplegia receive a higher level of reimbursement for postacute services than of reimbursement for postacute services than those with other insurance coverage…those with other insurance coverage…
BUT!!! ……There are very few published reviewed There are very few published reviewed
epidemiological works addressing SCIs that epidemiological works addressing SCIs that occur in the workplace ….occur in the workplace ….
……and even fewer, that estimate the post-and even fewer, that estimate the post-injury economics.injury economics.……
ASIA SCALEASIA SCALE
American Spinal Cord Injury Association (ASIA)American Spinal Cord Injury Association (ASIA)
Main topics influence the CostMain topics influence the Cost …. ….And…And…
epidemiology of work related spinal epidemiology of work related spinal cord injuriescord injuries
Cause of InjuryCause of Injury Injury epidemiological characteristicsInjury epidemiological characteristics
Healthcare Cost and Utilization ProjectHealthcare Cost and Utilization Project
Agency for Healthcare Research and Quality (AHRQ)Agency for Healthcare Research and Quality (AHRQ)
Hospitalization…Hospitalization…Medical costs by level of injury Medical costs by level of injury
for the first five years postinjuryfor the first five years postinjury
Nursing homeNursing home – includes facility charges with all other individually billed services – includes facility charges with all other individually billed services assigned to relevant subcategories.assigned to relevant subcategories.
Attendant careAttendant care – in-home health care from a nurse, personal care attendant or paid – in-home health care from a nurse, personal care attendant or paid family member. family member. ѴѴ
Physician carePhysician care – outpatient physician visits and diagnostic testing. – outpatient physician visits and diagnostic testing.
Outpatient therapyOutpatient therapy – outpatient physical, occupational, psychological and speech – outpatient physical, occupational, psychological and speech therapy.therapy.
DMEDME – includes items such as wheelchairs, beds, orthotics, exercise equipment, – includes items such as wheelchairs, beds, orthotics, exercise equipment, vehicle and home purchase or modifications vehicle and home purchase or modifications ѴѴ..
Medications and medical suppliesMedications and medical supplies – includes all medications and supplies (eg – includes all medications and supplies (eg catheters, gauze, gloves) used outside of a hospital/in-patient rehabilitation setting.catheters, gauze, gloves) used outside of a hospital/in-patient rehabilitation setting.
ReadmissionReadmission – hospital or rehabilitation readmission for SCI-related conditions. – hospital or rehabilitation readmission for SCI-related conditions. Routine urology, orthopedics, physiatry and neurology evaluations were not included Routine urology, orthopedics, physiatry and neurology evaluations were not included in this category. The payments included all payments for services provided except in this category. The payments included all payments for services provided except DME and were compiled from date of readmission to date of discharge.DME and were compiled from date of readmission to date of discharge.
Case managementCase management – case manager or management consultant charges. – case manager or management consultant charges.
TransportationTransportation – car service, ambulance transport and travel reimbursement that – car service, ambulance transport and travel reimbursement that occurred at any time other than the initial acute/rehabilitation admissions or occurred at any time other than the initial acute/rehabilitation admissions or readmissions.readmissions.
Vocational rehabilitationVocational rehabilitation – includes funding for job retraining, computer skills and – includes funding for job retraining, computer skills and vocational-learning equipment.vocational-learning equipment.
sseerrvviicceess
Mean expenditure for each service category for the 1st Mean expenditure for each service category for the 1st and remaining 4 years postinjuryand remaining 4 years postinjury – within injuriy levels– within injuriy levels
Re-Hospitalization…Re-Hospitalization…a significant cost to a significant cost to patients and society….patients and society….
The costs, length of, and reasons for re-hospitalizations following The costs, length of, and reasons for re-hospitalizations following work related tetraplegiawork related tetraplegia
outliers….outliers…. In many cases, patients spend more than the average time of In many cases, patients spend more than the average time of
Hospitalization. These patients are defined as “Hospitalization. These patients are defined as “OutliersOutliers” and ” and their lengths of stay exceeds the mean length of stay for spinal their lengths of stay exceeds the mean length of stay for spinal cord injury patients by more than two standard deviations cord injury patients by more than two standard deviations (Burnett 2000). Outliers took an average of (Burnett 2000). Outliers took an average of 17.8 days17.8 days longer to longer to get to rehabilitation than non-outliers…get to rehabilitation than non-outliers…
…the mean Year 1 costs for high-tetraplegia and low-tetraplegia cases were not found to be significantly different from one another….
when the major injury categories were compared (outliers when the major injury categories were compared (outliers removed), the mean removed), the mean Year 1 costsYear 1 costs for high-tetraplegia and low- for high-tetraplegia and low-tetraplegia cases were not found to be significantly different tetraplegia cases were not found to be significantly different
from one anotherfrom one another ????????????
……One reason to identify features of individuals who are length One reason to identify features of individuals who are length of stay outliers is to of stay outliers is to improve treatment efficiencyimprove treatment efficiency, which , which ultimately serves to reduce cost…ultimately serves to reduce cost…
Cost effectivenessCost effectiveness
Economic evaluations consider both the Economic evaluations consider both the costscosts and and consequencesconsequences of activities…in this case, of activities…in this case,
BUT….!@#%BUT….!@#% …….Most of the health care systems are .Most of the health care systems are
burdened by the heavy influence of burdened by the heavy influence of economics rather than functional outcome….economics rather than functional outcome….
The majority of the studies The majority of the studies are are cost analysescost analyses, , cost of cost of illness studiesillness studies or or cost cost function analysesfunction analyses, of limited , of limited use, because these types of use, because these types of studies are useful mainly to studies are useful mainly to decision makersdecision makers…. …. On the other hand, On the other hand, economists have questioned economists have questioned whether they can be an aid to whether they can be an aid to moving towards an moving towards an efficient efficient health care system….health care system….
…conclusions…. …The cost effectiveness evaluation, can be The cost effectiveness evaluation, can be
achieved using a large achieved using a large Randomized Control Randomized Control TrialTrial, which fully consider the costs and , which fully consider the costs and consequences of implementing consequences of implementing interventions….interventions….
there’s need to consider the parameters there’s need to consider the parameters mostly influences the cost outcome following mostly influences the cost outcome following SCIs, like the Hospitalization length of stay SCIs, like the Hospitalization length of stay and its dependence of the and its dependence of the quality of inpatient quality of inpatient and rehabilitation servicesand rehabilitation services provided and the provided and the re-Hospitalization causesre-Hospitalization causes and the relative and the relative preventionprevention must be taken…. must be taken….
