Long term outcomes and cost-implications of inequitable access to acuteinpatient rehabilitation

The federal Project Grant award of $371,024 from the National Research Service Awards Health Services Research Training program (CFDA 93.225) was provided to Northwestern University to conduct research on the long-term outcomes and cost implications of inequitable access to acute inpatient rehabilitation for patients with spinal cord injuries (SCI). The key objectives are to: 1) Characterize rates of medical complications like pressure ulcers, sepsis, and thrombosis among SCI patients who did and did not receive inpatient rehabilitation, 2) Quantify unplanned healthcare costs, such as rehospitalizations and emergency department visits, for these patient groups, and 3) Forecast the cost-effectiveness of improving access to appropriate post-acute rehabilitation care. This 18-month project, running from December 2024 to June 2026, aims to inform healthcare policy by better understanding the role of post-acute care on healthcare system costs for this patient population.

Abstract

Spinal cord injury (SCI) affects an estimated 294,000 patients in the united states and often occurs in the setting of trauma. Sequelae of SCI range from impaired sensorimotor function to complete paralysis, leading to detrimental effects on employment, social integration, and healthcare system utilization. Importantly, neurologic losses are mitigated by a post-acute care strategy which emphasizes rehabilitative care provided at acute inpatient rehabilitation facilities (irfs). Despite the benefits of IRF care for SCI patients, not all patients with spinal cord injuries are treated at irfs. Recent work from our group has shown that publicly insured SCI patients are less likely to receive care at irfs compared to privately insured patients, even after controlling for age, injury severity, and comorbidities. The reasons for this finding are unclear. IT is unknown to what degree lack of IRF care for SCI patients increases their long-term morbidity and healthcare utilization, and IT is unknown whether cost-savings from decreased long-term healthcare utilization would justify expanded access to IRF care. In aim 1, we will characterize rates of harm associated with SCI, such as pressure ulcers, urosepsis, and deep venous thrombosis, among patients who received IRF care versus those who did not. In aim 2, we will quantify rates of unplanned healthcare resource use, measured in dollar costs of rehospitalization and emergency department encounters, among SCI patients who received IRF care versus those who did not. In aim 3, we will forecast healthcare system costs associated with triaging patients to appropriate post-acute care rehabilitation and calculate the cost-effectiveness of such a move. The knowledge gained from this project will increase our understanding of the role of post-acute care on healthcare system costs and directly inform healthcare policy interventions regarding the post-acute care of trauma patients with spinal cord injury.