United States Veterans' Utilization of Spinal Cord Injuries and Disorders Annual Evaluation Services.

Sippel J, Etingen B, Stroupe K, Evans C, Huo Z, Frazier B, Wickremasinghe M, Smith B. United States Veterans' Utilization of Spinal Cord Injuries and Disorders Annual Evaluation Services. Archives of physical medicine and rehabilitation. 2024 Sep 27.

Related HSR&D Project(s)

• RCS 20-192 – Research Career Scientist Award

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Abstract:

OBJECTIVE: To evaluate Veterans' engagement in spinal cord injury and disorder (SCI/D) specialty annual evaluations (AEs). DESIGN: Cross-sectional retrospective cohort study. SETTING: SCI/D System of Care, United States Department of Veterans Affairs (VA). PARTICIPANTS: Veterans with SCI/Ds (N = 14,662). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Receiving SCI/D AEs during the study period (fiscal years [FY] 2019 and 2020). RESULTS: A total of 14,662 Veterans with SCI/Ds were included in the sample; 32.8% (n = 4811) received 2 AEs, 28.8% (n = 4219) received 1 AE, and 38.4% (n = 5632) received no AEs, with an average of 0.9 AEs per Veteran over the 2-year study timeframe (range, 0-2y). Black Veterans had an 8% higher number of AEs than White Veterans after adjusting for other variables (adjusted relative risk [RR], 1.08; 95% confidence interval [CI], 1.04-1.12). Veterans who lived 240 minutes away from a VA SCI/D System of Care Center had 45% fewer AEs than Veterans who lived within 30 minutes (adjusted RR, 0.55; 95% CI, 0.52-0.59). Veterans with more SCI/D specialty visits had 90% more AEs than those with fewer visits (adjusted RR, 1.90; 95% CI, 1.78-2.03), whereas Veterans with more outpatient visits in VA primary care had 28% fewer AEs (adjusted RR, 0.72; 95% CI, 0.69-0.76). Veterans with higher comorbidity scores had 9% more AEs than Veterans with lower scores (adjusted RR, 0.66; 95% CI, 0.61-0.70). CONCLUSIONS: More than half (62%) of Veterans received 1 SCI/D AE during FY19-20. Veterans living closer to a VA SCI/D System of Care Center/Hub had more engagement in SCI/D AEs. Veterans with SCI/Ds who used VA primary care outside of the SCI/D System of Care had fewer AEs. There were no major racial, age-based, or sex disparities in SCI/D AE usage. Our findings suggest the need for targeted intervention efforts to promote AE use among Veterans.