Veterans comprise almost 17% of the 250,000 persons with spinal cord injury/disorder (SCI/D) in the United States. Pressure ulcers are common complications of SCI/D. We compared annual health care utilization and costs between veterans with and without pressure ulcers in the Veterans Health Administration (VHA). Veterans with pressure ulcers had more total inpatient days on average (61.00 vs 9.19;P < .001) and higher total health care costs ($100,935 vs $27,914;P < .001) due primarily to higher inpatient costs ($91,341 vs $13,754;P < .05). Our results highlight the need to identify patients at risk for pressure ulcers who could benefit from targeted skin care management interventions.

health care cost, hospitalization, pressure ulcer, spinal cord injury/disorder, veteran
National Spinal Cord Injury Statistical Center (NSCISC). Spinal Cord Injury Facts and Figures at a Glance. Washington, DC: National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, US Department of Education; 2005.
Gelis A, Dupeyron A, Legros P, Benaim C, Pelissier J, Fattal C. Pressure ulcer risk factors in persons with spinal cord injury part 2: the chronic stage. Spinal Cord. 2009;47(9):651-661.
,
Pressure ulcer risk factors in persons with spinal cord injury part 2: the chronic stage
,
Spinal Cord.
, vol.
47
(pg.
651
-
661
)
Regan MA, Teasell RW, Wolfe DL, Keast D, Mortenson Aubut JA. tematic review of therapeutic interventions for pressure ulcers after spinal cord injury. Arch Phys Med Rehabil. 2009;90(2):213-231.
,
tematic review of therapeutic interventions for pressure ulcers after spinal cord injury
,
Arch Phys Med Rehabil.
, vol.
90
(pg.
213
-
231
)
Byrne DW, Salzberg CA. Major risk factors for pressure ulcers in the spinal cord disabled: a literature review. Spinal Cord. 1996;34(5):255-263.
,
Major risk factors for pressure ulcers in the spinal cord disabled: a literature review
,
Spinal Cord.
, vol.
34
(pg.
255
-
263
)
Fuhrer MJ, Garber SL, Rintala DH, Clearman R, Hart KA. Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors. Arch Phys Med Rehabil. 1993;74(11):1172-1177.
,
Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors
,
Arch Phys Med Rehabil.
, vol.
74
(pg.
1172
-
1177
)
Krause JS. Skin sores after spinal cord injury: relationship to life adjustment. Spinal Cord. 1998;36(1):51-56.
,
Skin sores after spinal cord injury: relationship to life adjustment
,
Spinal Cord.
, vol.
36
(pg.
51
-
56
)
Jones ML, Mathewson CS, Adkins VK, Ayllon T. Use of behavioral contingencies to promote prevention of recurrent pressure ulcers. Arch Phys Med Rehabil. 2003;84(6):796-802.
,
Use of behavioral contingencies to promote prevention of recurrent pressure ulcers
,
Arch Phys Med Rehabil.
, vol.
84
(pg.
796
-
802
)
Pressure ulcer prevention and treatment following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2001;24(Suppl 1):S40-101.
,
Pressure ulcer prevention and treatment following spinal cord injury: a clinical practice guideline for health-care professionals
,
J Spinal Cord Med.
, vol.
24
(pg.
S40
-
101
)
Richards JS, Waites K, Chen YY, Kogos K, Schumitt MM. The epidemiology of secondary conditions following spinal cord injury. Top Spinal Cord Inj Rehabil. 2004;10(1):15-29.
,
The epidemiology of secondary conditions following spinal cord injury
,
Top Spinal Cord Inj Rehabil.
, vol.
10
(pg.
15
-
29
)
Office of Public Affairs Media Relations. Fact Sheet: VA and Spinal Cord Injury. 2009. Washington, DC: Department of Veterans Affairs. http://www1.va.gov/opa/publications/factsheets/fs_spinal_cord_injury.pdf http://www1.va.gov/opa/publications/factsheets/fs_spinal_cord_injury.pdf
Yu W, Ravelo A, Wagner TH, Barnett PG. The relationships among age, chronic conditions, and healthcare costs. Am J Manag Care. 2004;10(12):909-916.
,
The relationships among age, chronic conditions, and healthcare costs
,
Am J Manag Care.
, vol.
10
(pg.
909
-
916
)
VIReC Research User Guide: FY 2002 VHA Medical SAS Inpatient Datasets. 2003. Hines, IL: Veterans Affairs Information Resource Center, Edward J. Hines, Jr VA Hospital. http://www.virec.research.va.gov/References/RUG/RUG-Inpatient02.pdf. Accessed January 28, 2011. http://www.virec.research.va.gov/References/RUG/RUG-Inpatient02.pdf.
VIReC Research User Guide: FY 2002 VHA Medical SAS Outpatient Datasets. 2003. Hines, IL: Veterans Affairs Information Resource Center, Edward J. Hines, Jr VA Hospital. http://www.virec.research.va.gov/ References/RUG/RUG-Inpatient02.pdf. Accessed January 28, 2011. http://www.virec.research.va.gov/
Smith MW, Chow A. Fee Basis Data: A Guide for Researchers. Menlo Park, CA: VA Palo Alto, Health Economics Resource Center; 2010.
,
Fee Basis Data: A Guide for Researchers.
Phibbs C, Barnett P, Fan A, Harden C, King S, Scott J. Research Guide to Decision Support System National Cost Extracts. Menlo Park, CA: Health Economics Resource Center of Health Service R&D Services, Department of Veterans Affairs; 2010. http://www.herc.research.va.gov/files/BOOK_621.pdf. Accessed January 28, 2011. http://www.herc.research.va.gov/files/BOOK_621.pdf
VIReC Research User Guide: VHA Pharmacy Prescription Data. 2nd ed. 2008. Hines, IL: Veterans Affairs Information Resource Center, Edward J. Hines, Jr VA Hospital. http://www.virec.research.va.gov/References/RUG/RUG-Pharmacy-2nd-Ed-er.pdf. Accessed January 28, 2011. http://www.virec.research.va.gov/References/RUG/RUG-Pharmacy-2nd-Ed-er.pdf
Thomas AJ, Eberly LE, Davey SG, Neaton JD. ZIP-code-based versus tract-based income measures as long-term risk-adjusted mortality predictors. Am J Epidemiol. 2006;164(6):586-590.
,
ZIP-code-based versus tract-based income measures as long-term risk-adjusted mortality predictors
,
Am J Epidemiol.
, vol.
164
(pg.
586
-
590
)
Efron B, Tibshirani R. An Introduction to the Bootstrap. New York: Chapman and Hall; 1993.
,
An Introduction to the Bootstrap.
Vuong Q. Likelihood ratio tests for model selection and non-nested hypotheses. Econometrica. 1989;57(2):307-333.
,
Likelihood ratio tests for model selection and non-nested hypotheses
,
Econometrica.
, vol.
57
(pg.
307
-
333
)
Long JS, Freese J. Regression Models for Categorical Dependent Variables Using Stata. 2nd ed. College Station, TX: Stata Press; 2006.
,
An Introduction to the Bootstrap.
Barber J, Thompson S. Multiple regression of cost data: use of generalised linear models. J Health Serv Res Policy. 2004;9(4):197-204.
,
Multiple regression of cost data: use of generalised linear models
,
J Health Serv Res Policy.
, vol.
9
(pg.
197
-
204
)
McCullagh P, Nelder J. Generalized Linear Models. 2nd ed. London: Chapman and Hall; 1989.
,
An Introduction to the Bootstrap.
Blough DK, Madden CW, Hornbrook MC. Modeling risk using generalized linear models. J Health Econ. 1999;18(2):153-171.
,
Modeling risk using generalized linear models
,
J Health Econ.
, vol.
18
(pg.
153
-
171
)
Manning WG, Mullahy J. Estimating log models: to transform or not to transform? J Health Econ. 2001;20(4):461-494.
,
Estimating log models: to transform or not to transform?
,
J Health Econ.
, vol.
20
(pg.
461
-
494
)
Buntin MB, Zaslavsky AM. Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. J Health Econ. 2004;23(3):525-542.
,
Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures
,
J Health Econ.
, vol.
23
(pg.
525
-
542
)
French DD, Campbell RR, Sabharwal S, Nelson AL, Palacios PA, Gavin-Dreschnack D. Health care costs for patients with chronic spinal cord injury in the Veterans Health Administration. J Spinal Cord Med. 2007;30(5):477-481.
,
Health care costs for patients with chronic spinal cord injury in the Veterans Health Administration
,
J Spinal Cord Med.
, vol.
30
(pg.
477
-
481
)
Yu W, Ravelo A, Wagner TH, et al. Prevalence and costs of chronic conditions in the VA health care system. Med Care Res Rev. 2003;60(3 Suppl):146S-167S.
,
Prevalence and costs of chronic conditions in the VA health care system
,
Med Care Res Rev.
, vol.
60
(pg.
146S
-
167S
)
Smith BM, LaVela SL, Weaver FM. Health-related quality of life for veterans with spinal cord injury. Spinal Cord. 2008;46(7):507-512.
,
Health-related quality of life for veterans with spinal cord injury
,
Spinal Cord.
, vol.
46
(pg.
507
-
512
)
DeVivo MJ, Whiteneck GG, Charles ED. The economic impact of spinal cord injury. In: Stover SL, DeLisa JA, Whiteneck GG, eds. Spinal Cord Injury: Clinical Outcomes from the Model Systems. Gaithersburg, MD: Aspen Publishers; 1995:234-271.
,
The economic impact of spinal cord injury.
,
An Introduction to the Bootstrap.
(pg.
234
-
271
)
This content is only available as a PDF.