RESUMEN
BACKGROUND: The increasing prevalence of individuals experiencing disabilities underscores the importance of rehabilitation. Nevertheless, healthcare systems are already facing financial constraints, which makes it imperative to strive for a more efficient delivery of services. The first step, however, is to understand how the provision of services behaves for patients with different characteristics. AIM: To determine the most frequently used healthcare services in the (sub)acute phase of rehabilitation of patients with spinal cord injury/disease (SCI/D) and the link with patient characteristics. DESIGN: Observational cohort study. POPULATION: This study analyzes the clinical data of patients discharged from a specialized SCI hospital and rehabilitation center in Switzerland. METHODS: We implemented a compound risk model to estimate the total amount of healthcare services used, defined by length of stay (LOS) and the units per day of health services (sub)acute phase of rehabilitation. RESULTS: The study included 403 individuals with SCI/D. The analysis of the intensity and severity of healthcare services across different patient and injury characteristics revealed differences in the intensity of healthcare use and variations in the length of stay (LOS). Male patients with a low SCIM upon admission tended to use healthcare services more extensively than female patients. In terms of etiology, therapies were employed more intensively for patients with traumatic SCI (TSCI). In addition, the analysis revealed that variations in the intensity of healthcare services used were more significant than those adjusted for LOS. Ultimately, similar patient groups received comparable quantities of healthcare services at the end of treatment. CONCLUSIONS: This population-based study provides information for a better understanding of the determinants of health service use during the (sub)acute rehabilitation phase of individuals with SCI/D. When analyzing LOS, intensity, and severity of services, it shows that the use of healthcare services significantly differs for the level of SCIM at admission, age groups, sex, and etiology. However, the variation among individual patients also suggests the presence of other influential modifiers that were not considered in this analysis. CLINICAL REHABILITATION IMPACT: The approach outlined enables a systematic follow-up of this data analysis by enriching the computed data with additional details about the patient, the patient's treatment, and outcomes.
Asunto(s)
Tiempo de Internación , Centros de Rehabilitación , Traumatismos de la Médula Espinal , Humanos , Traumatismos de la Médula Espinal/rehabilitación , Femenino , Masculino , Persona de Mediana Edad , Suiza , Adulto , Tiempo de Internación/estadística & datos numéricos , Centros de Rehabilitación/estadística & datos numéricos , Estudios de Cohortes , AncianoRESUMEN
Objectives: To estimate the effect of having a chronic disease on the weekly working hours and the associated monetary losses. Design: Longitudinal data Survey of Health, Aging and Retirement (SHARE) in Europe. We analyzed 7 waves from 9 countries in Europe. A total of 80.672 observations. Setting: Participants who have their regular domicile in the respective SHARE country were interviewed face-to-face. Participants: Data from individuals aged between 50 and 65 years old in European countries were collected over seven years. A person was excluded from the survey if incarcerated, hospitalized or out of the country during the entire survey period, unable to speak the country's language(s) or moved to an unknown address. Interventions: Not applicable. Main outcome measurements: We applied a difference-in-differences with multiple time periods approach to estimate the effect of having a chronic condition on the number of working hours per week. We monetized the estimated productivity losses using the legal minimum wage in each country. Results: Persons with a chronic condition consistently reduced their weekly working hours compared to their healthy counterparts in the same country. This effect was more pronounced for men (6,78 hours per week or 352 hours per year) than women (3,97 hours per week or 206 hours per year). Persons with stroke, vascular, and lung disease showed the highest impact. On average, the reduced working hours represent about USD 12,80 billion annually in productivity losses in our sample. Conclusion: Having a chronic condition leads to people decreasing their working hours, which has significant economic losses. More severe health conditions showed the highest effects. This trend is observed in all the analyzed countries, highlighting the relevance of health and social systems to go beyond mortality and morbidity and the need to incorporate functioning in their target goals.