Functional outcomes in spinal cord injury (SCI): quality care versus cost containment

Our ability to assess functional outcomes in SCI has recently been improved by agreement with standards for neurological and functional classification of spinal cord injury. This widely accepted classification should allow uniform measures of impairment and disability and serve as the gold standard for functional outcomes. Measures of impairment allow comparison of more than 15,000 subjects with Frankel grades and severity of paralysis reported to the National Database and comparison of the disability measures, the Functional Independence Measure (FIM) in over 2,500 cases which correlates with level and severity of paralysis. These standards are currently in use in several multicenter drug trials and should yield information regarding the effects of pharmacological interventions on impairment/function in the next several years. Studies of the effects of surgery, exercise and health care systems are beginning to emerge. Some investigators suggest social roles, perceived improvement and quality of life scales will be powerful tools in shaping health care reform. More recently, cost efficiency has been added to traditional studies of safety, efficacy and effectiveness. Quality Adjusted Life Years (QALY) and value-added care are new terms introduced into health care. Cost containment proponents are cautioned that improved value and added quality care may result in greater cost efficiency, but not reduced costs. Spinal cord injury care in the future must be cost efficient and, in addition, improve the health status and satisfy the consumer.