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• W647909068 abstract "Background/purpose: The most recent incidence studies of SCI in the US estimate that there are 12,000 new cases of injury survivors per year with an estimated prevalence of 270,000. Approximately 13% of new SCI patients are provided services at one of 14 federally funded Spinal Cord Injury Models Systems Hospitals (SCIMS) (Spinal Cord Facts 2012). The purpose of this review is to identify whether or not individuals with Spinal Cord Injury who receive services within a specialized system of care, such as that provided at the SCIMS hospitals, have better functional outcomes, decreased length of stay and/or decreased incidence of secondary medical complications. Case Description: A data base review of PubMed, CINAHL plus with full text, REHABDATA, Cochrane, and PEDro was conducted using combinations of the following key words: spinal cord injury, outcomes, functional outcomes, length of stay, specialized, specialised, organized, organised, skilled nursing facility, rehabilitation, and complications.. Outcomes and Discussion: Research from the US SCIMS hospitals and specialized SCI centers in other countries has provided very low quality evidence that specialized and integrated SCI care, from onset of injury through community reintegration, reduces secondary medical complications and length of stay and concomitantly increases functional outcomes at discharge. No research has been identified which attempts to fetter out which specific qualities or characteristics of model systems contribute to these improved outcomes. SPECIALIZED CARE FOR SPINAL CORD INJURY 3 Specialized Care for Spinal Cord Injury: Impact on Functional Outcomes, Secondary Medical Complications and Length of Stay Background and Purpose Spinal Cord Injury is a life altering injury with profound impact on an individual’s general health, life expectancy, functional abilities, self-perception, and quality of life. Improved acute stabilization methods and awareness have led to reduced mortality rates and increased numbers of individuals requiring rehabilitation (Oliver, 2012). In 1970 the National Institute for Disability Rehabilitation Research (NIDRR) under the Department of Education issued its first grants for Spinal Cord Injury Model Systems Hospitals. There are currently 14 SCIMS hospitals which are awarded grants in 5 year cycles (http://www.msktc.org/sci/model-system-centers). Federal grants provided to SCIMS hospitals tally up to an average of 8 to 9 Million dollars per year (http://www2.ed.gov/programs/sci/funding.html). Recipient hospitals are required to participate in data collection, individual and collaborative research projects (http://www.msktc.org/sci/model-system-centers). These programs are charged with data collection during and after the grant cycle, providing comprehensive SCI care and information, and conducting research to advance the knowledge base and application of SCI rehabilitation interventions. (http://www.msktc.org/sci/model-system-centers). Since 1984, data collected from SCIMS hospitals has been maintained by the National Data and Statistical Center for Spinal Cord Injury (Lammertse, 2004). This data base has been the well from which data has been drawn for many retrospective data base reviews including those geared toward assessing program efficacy and efficiency. SPECIALIZED CARE FOR SPINAL CORD INJURY 4 Spinal Cord Injury has relatively low incidence and prevalence rates compared to many other diagnoses. There are an estimated 12,000 new cases of SCI (not including those who die at the scene) in the US per year with an overall prevalence estimated between 236,000 and 327,000 persons (SCI Facts and Figures, 2012). Most medical professionals do not encounter patients with SCI on a frequent basis. Many of them, therefore, may not be as prepared or adept as those professionals in a SCIMS hospital setting who work with SCI daily and make it a priority to stay up to date on SCI research. For the 13% of SCI patients who receive services at a SCIMS hospital, this might be comforting information to ponder. What, however, is the impact of centralized specialization for the 87% of SCI patients who receive their care in community hospitals and general rehabilitative centers? Many individuals are further diverted from these general settings to facilities such as skilled nursing facilities, which may be even less prepared to meet their highly specialized needs. The purpose of this paper is to assess the current research regarding outcomes in specialized SCI centers of care versus non-specialized. More specifically, do persons with Spinal Cord Injury (SCI) have reduced length of stay (LOS), reduced mortality and/or reduced incidence of medical complications when they receive care at a SCIMS hospital vs. a non-SCIMS hospital? Case Description On November 16, 2012 a 40 year old male patient (ST) with a diagnosis of C7 spinal cord injury was admitted to an inpatient rehabilitation facility in Albuquerque, New Mexico. The facility is accredited for SCI rehabilitation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The patient’s date of injury was in February, 2012. Secondary to multiple medical complications, the patient has been hospitalized for the last nine months and has received minimal rehabilitation. Upon his arrival to the inpatient rehab in SPECIALIZED CARE FOR SPINAL CORD INJURY 5 November, his insurance approved him for one week of rehabilitation and SCI education with discharge goal of discharge to family. Patient records from previous hospitalizations are limited. A brief subjective history of placements and interventions is as follows: DATE LOS POS Intervention/comments February, 2012 ~1 week UNLV Hospital Surgical stabilization February, 2012 ~1 week Harmon Rehab 1 hour/day tx. Too weak to participate, became “ill” but doesn’t recall details. Sent to hospital. March, 2012 ~3-4 days UNLVH Doesn’t recall. Remembers food tray in front of him and not being able to feed himself. March, 2012 ~30 days Healthsouth Inpatient Rehabilitation, Las Vegas, NV Unable to participate in tx secondary to orthostatic hypotension and weakness. Stage I pressure ulcer on sacrum at end of stay. April, 2012 ~100 days Clearview SNF, Henderson NV 1⁄2 hr. of therapy per day. Still very weak. Multiple UTIs, hospitalization for DVT, PE. Possible hip fx due to spasticity pulling him off his bed. June, 2012 ~2 weeks St Rose Hospital, Las Vegas, NV Stage IV pressure ulcer on sacrum. Colostomy, IVC Filter placement, July, 2012 ~1 week Kindred Hospital, Las Vegas, NV July, 2012 ~1 week St Rose Hospital, Las Vegas, NV Colostomy revision x2 secondary to hematoma and gangrene. August, 2012 20 days Kindred Hospital, Hyperbaric Oxygen SPECIALIZED CARE FOR SPINAL CORD INJURY 6 Las Vegas, NV Chamber 2hrs per day for wound healing September, 2012 Kindred Hospital, Albuquerque, NM Pt. hired medi-vac to bring him to NM, closer to family 9/16/2012 9 days Christus St Vincent, Santa Fe NM Wound debridement, dx with osteomyelitis in the sacrum (MRSA, proteus mirabilis) begin antibiotic therapy (ABT). 9/21/12 Flap closure. 9/25/2012 ~7 weeks Kindred Hospital, ABQ, NM Continue ABT, ultrasound for wound healing, air fluidized bed, no out of bed x 6 weeks, then protocol to increase sitting tolerance 11/16/2012 17 days Healthsouth, ABQ, NM Functional rehabilitation, strengthening and patient education Examination History/Medical History: At the time of injury, ST was a single, divorced, 39 year old male who was a recently unemployed journeyman plumber. He had made a decision to move to New Mexico for employment and to be closer to family. He was temporarily residing with a friend while he rented out his primary residence as he made this transition. He reports that he was physically active and worked out at the gym three to four times per week including resistance and cardio training. He had no significant prior medical history and considered himself to be in excellent" @default.
• W647909068 created "2016-06-24" @default.
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• W647909068 date "2014-03-21" @default.
• W647909068 modified "2023-09-27" @default.
• W647909068 title "Specialized Care for Spinal Cord Injury: Impact on Functional Outcomes, Secondary Medical Complications and Length of Stay" @default.
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