Trends in nonroutine physician visits and hospitalizations: findings among five cohorts from the Spinal Cord Injury...

Longitudinal cohort study OBJECTIVE: To evaluate lifetime variation in healthcare utilization among individuals with a chronic spinal cord injury (SCI).

Medical university in the Southeastern United States (US).

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.

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.

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.