Abstract
Objective
To examine the risk of any and specific potentially preventable hospitalizations (PPHs)
for adults with cerebral palsy (CP) or spina bifida (SB). We hypothesize that PPH
risk is greater among adults with CP/SB compared with the general population.
Patients and Methods
Using January 1, 2007, to December 31, 2017, national private administrative claims
data (OptumInsight) in the United States, we identified adults with CP/SB (n=10,617).
Adults without CP/SB were included as controls (n=1,443,716). To ensure a similar
proportion in basic demographics, we propensity-matched our controls with cases in
age and sex (n=10,617). Generalized estimating equation models were applied to examine
the risk of CP/SB on PPHs. All models were adjusted for age, sex, race/ethnicity,
health indicators, US Census Division data, and socioeconomic variables. Adjusted
odds ratios were compared within a 4-year follow-up.
Results
Adults with CP/SB had higher risk for any PPH (odds ratio [OR], 4.10; 95% CI, 2.31
to 7.31), and PPHs due to chronic obstructive pulmonary disease/asthma (OR, 1.85;
CI, 1.23 to 2.76), pneumonia (OR, 3.01; 95% CI, 2.06 to 4.39), and urinary tract infection
(OR, 6.48; 95% CI, 3.91 to 10.75). Cases and controls who had an annual wellness visit
had lower PPH risk (OR, 0.52; 95% CI, 0.41 to 0.67); similarly, adults with CP/SB
who had an annual wellness visit compared with adults with CP/SB who did not had lower
odds of PPH (OR, 0.75; 95% CI, 0.60 to 0.94).
Conclusion
Adults with pediatric-onset disabilities are at a greater risk for PPHs. Providing
better access to preventive care and health-promoting services, especially for respiratory
and urinary outcomes, may reduce PPH risk among this patient population.
Abbreviations and Acronyms:
AHRQ (Agency for Healthcare Research and Quality), COPD (chronic obstructive pulmonary disease), CP (cerebral palsy), ICD (International Classification of Diseases), OR (odds ratio), OT (occupational therapy), PPH (potentially preventable hospitalization), PT (physical therapy), SB (spina bifida), UTI (urinary tract infection)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cerebral palsy and aging.Dev Med Child Neurol. 2009; 51: 16-23
- Prospective memory in adults with spina bifida.Childs Nerv Syst. 2010; 26: 1749-1755
- Cerebral palsy: causes, pathways, and the role of genetic variants.Am J Obstet Gynecol. 2015; 213: 779-788
- Genomic approaches to the assessment of human spina bifida risk.Birth Defects Res. 2017; 109: 120-128
- Prospective and episodic memory in relation to hippocampal volume in adults with spina bifida myelomeningocele.Neuropsychology. 2015; 29: 92-101
- Prenatal ischemia deteriorates white matter, brain organization, and function: implications for prematurity and cerebral palsy.Dev Med Child Neurol. 2016; 58: 7-11
- Effects of cognitive, motor, and sensory disabilities on survival in cerebral palsy.Arch Dis Child. 2001; 86: 84-89
- Profile of hospital admissions for adults with cerebral palsy: a retrospective cohort study.Dev Med Child Neurol. 2020; 62: 939-945
- Use of primary prevention services among male adults with cerebral palsy, multiple sclerosis, or spinal cord injury in managed care and fee-for-service.Manag Care Q. 2004; 12: 6-10
- Pain phenotypes among adults living with cerebral palsy and spina bifida.Pain. 2021; 162: 2532-2538
- Psychological morbidity among adults with cerebral palsy and spina bifida.Psychol Med. 2021; 51: 694-701
- Cardiometabolic morbidity in adults with cerebral palsy and spina bifida.Am J Med. 2020; 133: e695-e705
- Approach for achieving effective care for high-need patients.JAMA Intern Med. 2018; 178: 845-846
- Prevalence of high-burden medical conditions and health care resource utilization and costs among adults with cerebral palsy.Clin Epidemiol. 2019; 11: 469-481
- Health conditions, functional status and health care utilization in adults with cerebral palsy.Fam Pract. 2018; 35: 661-670
- Reasons for hospital admissions among youth and young adults with cerebral palsy.Arch Phys Med Rehabil. 2011; 92: 46-50
- AHRQ quality indicators.in: Hughes R.G. Patient Safety and Quality: An Evidence-based Handbook for Nurses. Agency for Healthcare Research and Quality (US), 2008 (chapter 45)
- Nationwide frequency and costs of potentially preventable hospitalizations, 2006.in: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US), 2009 (statistical brief #72)
- Hospitalization for urinary tract infections and the quality of preventive health care received by people with spina bifida.Disabil Health J. 2009; 2: 145-152
- Predicting respiratory hospital admissions in young people with cerebral palsy.Arch Dis Child. 2018; 103: 1119-1124
- Traumatic spinal cord injury and risk of early and late onset Alzheimer’s disease and related dementia: large longitudinal study.Arch Phys Med Rehabil. 2021; 102: 1147-1154
- Mental health disorders and chronic disease among adults with spinal cord injury.Arch Phys Med Rehabil. 2019; 100: e97
- Agency for Healthcare Reseach and Quality (AHRQ).https://qualityindicators.ahrq.gov/Modules/pqi_resources.aspx#techspecsDate accessed: October 15, 2021
- Prevention Quality Indicators Technical Specifications. Updated Prevention Quality Indicators Technical Specifications (PDF Format), Version v2021. Agency for Healthcare Research and Quality (AHRQ).https://qualityindicators.ahrq.gov/archive/pqi_techspec/icd10_v2020Date accessed: October 15, 2021
- Prevention Quality Indicator 90 (PQI 90) Prevention Quality Overall Composite.https://qualityindicators.ahrq.gov/Downloads/Modules/PQI/V2021/TechSpecs/PQI_90_Prevention_Quality_Overall_Composite.pdfDate: July 2021Date accessed: October 15, 2021
- Musculoskeletal morbidity following spinal cord injury: a longitudinal cohort study of privately-insured beneficiaries.Bone. 2021; 142115700
- What do we really know about the transition to adult-centered health care? A focus on cerebral palsy and spina bifida.Arch Phys Med Rehabil. 2007; 88: 1064-1073
- Cerebral palsy grows up.Mayo Clinic Proc. 2021; 96: 1404-1406
- Hospitalizations of adults with spina bifida and congenital spinal cord anomalies.Arch Phys Med Rehabil. 2010; 91: 529-535
- 21st century challenges to the provision of health care to adults with spina bifida: a rehabilitation approach.Arch Phys Med Rehabil. 2014; 95: 1601-1602
- Use of health care among adults with chronic and complex physical disabilities of childhood.Disabil Rehabil. 2005; 27: 1455-1460
- Cerebral palsy: an overview.Am Fam Physician. 2006; 73: 91-100
- Mortality due to cardiovascular disease, respiratory disease, and cancer in adults with cerebral palsy.Dev Med Child Neurol. 2019; 61: 924-928
- Medical complication in adults with spina bifida.Clin Neurol Neurosurg. 2013; 115: 1226-1229
- Emergent care patterns in patients with spina bifida: a case-control study.J Urol. 2015; 193: 268-273
- Variation in definitions of urinary tract infections in spina bifida patients: a systematic review.Pediatrics. 2013; 132: 132-139
- Factors affecting mortality and morbidity in adult spina bifida.Eur J Pediatr Surg. 1999; 9: 31-32
- Urologic disorders are still the leading cause of in-hospital death in patients with spina bifida.Urology. 2020; 137: 200-204
- Urologic management of spina bifida.Dev Disabil Res Rev. 2010; 16: 88-95
- The adult with cerebral palsy.Arch Fam Med. 2000; 9: 466-472
- Systematic review of the economic impact of cerebral palsy.Res Dev Disabil. 2018; 80: 93-101
- Adolescents with cerebral palsy: transitioning to adult health care services.Clin Pediatr (Phila). 2014; 53: 356-363
- A and B Recommendations. A listing of all the Recommendations with grade of either A or B. U.S. Preventive Services Task Force (USPSTF). Published 2021.https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendationsDate accessed: June 15, 2021
- Exercise and physical activity recommendations for people with cerebral palsy.Dev Med Child Neurol. 2016; 58: 798-808
Article info
Publication history
Published online: November 03, 2022
Footnotes
For editorial comment, see page 2186
Grant Support: This research was developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR #90RTHF0001-01-00).
Identification
Copyright
© 2022 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Health Care for Adults With Cerebral Palsy and Spina Bifida—Must It Be so Difficult?Mayo Clinic ProceedingsVol. 97Issue 12
- PreviewFor children with cerebral palsy and spina bifida (CP/SB), their complex medical needs are often coordinated through a medical home or multidisciplinary clinic setting. In these settings, a care team works to coordinate appointments, follow up on missed appointments, and facilitate communication with and between medical providers and patients. This care coordination is often done through many methods and contact points. Despite this, children with CP/SB may still have unexpected or potentially preventable hospitalizations (PPHs) for urinary tract infection (UTI), pneumonia, pressure wounds, and other illnesses.
- Full-Text
- Preview