Changing Trends in SCI Patterns, Prevalence, Morbidity

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Changing Trends in SCI Patterns, Prevalence,
Morbidity Hospitalisation Challenging Models of
Care Resource Allocation

• Dr James Middleton MBBS, PhD Medical
  Director,Moorong Spinal Unit,Royal
  Rehabilitation Centre Sydney

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SCI Demographics What we know

• From Australian Spinal Cord Injury Register
• Incidence rates (12/million)
• Age and gender distribution
• Bimodal, MalegtgtFemale, lt35yrs over represented
• Distribution of neurological level degree of
  severity (2002/03, NISU)
• Complete Incomplete
• Tetraplegia 17 42
• Paraplegia 23 18

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Trends in NSW Incidence rates advised by ASCIR

• Overall rates fairly stable 85 p.annum
• Proportion of persons with tetraplegia increasing
• Proportion with incomplete lesions also
  increasing, from 60 in 1995-97 to 65 in
  1998-2003

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SCI Demographics What we know (cont)

• From other National/State studies
• Mortality rates (Yeo et al, 1998 OConnor, 2002)
• Rehospitalisation rates (Middleton et al, 2004)
• Prevalence can be estimated from the above data

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Life Expectancy

• Tetraplegia (ASIA A)
• 70-77
• Paraplegia (ASIA A)
• 84-91
• Incomplete (ASIA D)
• 92-96
• (Yeo et al, 1998)

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Rehospitalisation Rates

• Middleton et al, 2004

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Example NSW estimates

• Traumatic incidence rates range between 80 90
  per annum, across a population of 6 million
• About 45/55 Para/Tetraplegia, 70 ASIA A-C/30
  ASIA D, 80/20 Male/Female
• Mortality rates varies by age around 8 times
  population at young ages, up to double at
  advanced age (expectation of life reduced by up
  to 30)
• Morbidity long term readmission rate 0.5
  (ASIA A-C) 0.25 (ASIA D) per person at risk per
  year, with ALOS of 15 days so 6.4 days per
  annum per person
• Prevalence around 3,000 3,500
• Implied overall morbidity up to 22,400 bed-days
  per annum, plus community-based morbidity !!!

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SCI Demographics What we dont know

• Community-based morbidity
• Unmet need for services and support
• Quality of life
• Employment status
• Other socio-economic indicators
• Impact of ageing
• Overall burden of disease
• Nb much of this is better known in Victoria (TAC)

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Potential sources of information

• Enhanced spinal injury registry possibly?
• HACC and Disability Services data
• too broad non-specific to be useful
• Department of Health data improving
• Accident compensation data lots of potential
  (eg Victorian TAC proposed national scheme)
• Medicare (HIC Database), ?PBS, ??other sources
• Ideally, links between all of the above
• unique identifier acceptable under privacy
  regulations

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Long Term Care Project

• National Insurance Ministers (Finance and
  Treasury) are investigating the feasibility of a
  universal no-fault compensation scheme for SCI
  and traumatic Brain Injury
• This initiative has the potential to provide the
  catalyst for improved service delivery, outcome
  evaluation and data linkages

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Estimated cost model for Long Term Care project

• This model translates to an annual incurred
  liability of about 100m in NSW

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Issues Challenging Future Models of Care

• Casemix classification systems cost pressures
  driving need for increased efficiency shortened
  LoS in SIU
• ambulatory rehabilitation programs
• High health system utilisation costs associated
  with growing prevalent and ageing SCI population
• Identify high-risk individuals - complex
  interaction of personal, injury-related,
  psychosocial environmental factors!

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Issues Challenging Future Models of Care

• Maintenance of health well-being, social
  activity, employment quality of life
• Regular systematic follow-up with improved
  surveillance
• Ensure accessible, informed health services
  available when complications arise
• Breakdown barriers of physical access,
  professional attitudes lack of expertise about
  SCI and consequences
• Socio-economic factors also contribute!