Traumatic spinal cord injury in West Virginia: Disparities by insurance and discharge disposition from an acute care hospital

The Journal of Spinal Cord Medicine, 2020 · DOI: 10.1080/10790268.2018.1544878 · Published: January 1, 2020

Spinal Cord Injury Healthcare Public Health

Simple Explanation

This study examines if having Medicaid insurance affects the care and outcomes for people with spinal cord injuries (SCI) in West Virginia compared to those with other insurance types. The study found that Medicaid patients with SCI stayed in the hospital longer, had higher charges, and were more likely to be discharged to a nursing home or their own home rather than a rehabilitation center. This is likely because Medicaid in West Virginia doesn't cover intensive rehabilitation services, which are important for recovery after a spinal cord injury.

Study Duration

2009 to 2016

Participants

200 adult patients with traumatic spinal cord injury

Evidence Level

Retrospective review

Key Findings

1
Medicaid beneficiaries had a significantly longer length of stay (20.9 days; P < .001) when compared to all other patients.
2
Medicaid patients were less likely to be discharged to rehabilitation centers as compared to non-Medicaid patients (P < .01).
3
Inpatient charges billed for Medicaid beneficiaries were significantly higher than those of non-Medicaid patients (203,264 USD vs 140,114 USD; P = .015).

Research Summary

Medicaid patients with SCI in West Virginia experienced longer hospital stays, higher billed charges, and were more frequently discharged to home or skilled nursing facilities compared to non-Medicaid patients. The study suggests that the limited availability of rehabilitation facilities for Medicaid beneficiaries is a significant contributing factor to these disparities. The findings highlight the need for healthcare reform to address disparities in access to specialized rehabilitation for Medicaid recipients with SCI to ensure equitable care and improve outcomes.

Practical Implications

Policy Changes

Advocate for policy changes to ensure Medicaid coverage includes access to acute inpatient rehabilitation facilities for individuals with SCI in West Virginia.

Resource Allocation

Allocate resources to increase the availability of rehabilitation facilities that accept Medicaid patients, addressing the disparity in access to specialized care.

Further Research

Conduct further studies to investigate the long-term outcomes, quality of life, and adverse events associated with decreased rehabilitation services for Medicaid patients with SCI.

Study Limitations

1
Data drawn from a single hospital data bank.
2
Statistical methods did not control for patient characteristics such as age or severity of injury.
3
Long-term outcomes for people with SCI related to insurance coverage remain to be seen

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