Michigan spinal cord injury model systems - spinal cord injury (SCI) is associated with lifelong physical disability and high rates of chronic and secondary conditions, including cognitive impairment

These conditions increase mortality, hospitalizations, and healthcare costs while decreasing life span, quality of life and community participation. Individuals from low-income and racially marginalized backgrounds often experience the highest levels of negative outcomes. All too often, healthcare systems are not adequately designed to address the needs of individuals with disabilities. Factors in the built, policy-related, and attitudinal environments interact to create or exacerbate health and healthcare disparities for individuals with SCI. These factors are further compounded by a lack of integrated evidence-based protocols and decision-making tools. In particular, while physiatrists and other rehabilitation providers may have the training and expertise to support individuals with SCI in preventing or managing secondary or chronic conditions, most other types of healthcare providers have neither the awareness nor the training to do so and require decision-making tools and standardized protocols to inform their care. IT is for this reason that the overarching focus of the michigan spinal cord injury model systems (MI-scims) center is to enhance the chronic care management of individuals living with SCI through our research, dissemination, and collaborative activities. Through our site-specific research project, we will develop and test the reliability, predictive validity and clinical utility of an SCI hospitalization risk index, which will have the capacity to use information extracted from electronic health records (EHR) to facilitate proactive clinical decision-making and referrals. A multi-method iterative process will be used to achieve these goals, including: - iterative development of algorithms to predict hospitalization for adults with chronic SCI using machine learning and associated analyses of medicare / medicaid insurance claims, with consideration for different individual characteristics (e.g., level of injury, race, social determinants of health) and risk factors (e.g., chronic and secondary conditions); - evaluation of reliability and predictive validity of the SCI hospitalization risk index (SCI HRI) using data extracted from EHR; and - the implementation of a delphi survey to determine its clinical utility, feasibility, and implementation effectiveness of the SCI HRI. This work will enable efficient and targeted planning for these patients to reduce hospital readmission and wasteful spending, as well as preventable morbidity and early mortality. Our collaborative research module will use a cross-sectional telehealth-based assessment to examine the relationships between executive functioning, self-management and health and psychosocial outcomes among adults with chronic SCI. Using a large stratified sample collected across multiple sites, information from this study will be used to enhance understanding of the cognitive skills needed to manage the complexities of life after SCI and inform the implementation of future interventions and clinical care. Both research projects will include sufficient engagement and information from persons of color (POC) and individuals with SCI in racially marginalized communities to generate new knowledge relevant to these populations. Finally, in addition to engaging with and addressing the needs of individuals living with SCI, as well as other traditional stakeholders, our dissemination activities include innovative strategies, such as EHR best-practice alerts and policy briefs, designed to improve the knowledge of clinicians and enhance healthcare systems. Critical to each of these components is the participation of individuals with SCI, particularly those from low-income and racially marginalized backgrounds, to ensure that project activities are relevant, accessible, and EN