Effectiveness of a Wellness Program for Individuals With Spina Bifida and Spinal Cord Injury Within an Integrated Delivery System

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• 作者：Brad E. Dicianno ; MD^a ; ^{dicianno@pitt.edu" class="auth_mail" title="E-mail the corresponding author} ; John Lovelace ; MS^b ; Pamela Peele ; PhD^b ; ^c ; Christopher Fassinger ; RN^b ; Patricia Houck ; MSH^b ; Alexandra Bursic ; BA ; BS^a ; Michael L. Boninger ; MD^a
• 关键词：Emergency service ; hospital ; Health promotion ; Hospitalization ; Pressure ulcer ; Preventive medicine ; Rehabilitation ; Sepsis ; Spinal cord injuries ; Spinal dysraphism ; Urinary tract infections
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：97
• 期：11
• 页码：1969-1978
• 全文大小：351 K

文摘

To determine whether an evidence-based wellness program for individuals with spina bifida and spinal cord injury would improve health outcomes and patient experience of care, result in a positive return on investment (ROI), and provide evidence for scalability.

Design

Nonrandomized, noncontrolled cohort study; 2 years of enrollment.

Setting

Academic hospital-based outpatient physiatry clinic partnered with an insurance division within an integrated health care delivery and financing system.

Participants

Individuals (N=69) with spina bifida and spinal cord injury were consented; 4 were excluded (5.7%), and the remaining 65 (94.2%) participated in the intervention.

Interventions

Evidence-based wellness program consisting of care coordination from a mobile nurse, patient education, and patient incentives.

Main Outcome Measures

Validated measures of function, mood, quality of life, and perception of care delivery; knowledge of preventable conditions; self-rating of health; and utilization and cost.

Results

Improvements in all main outcome measures were seen after 2 years of enrollment. Although cost in year 1 of enrollment increased because of hospitalizations and the overall ROI was negative, a small positive ROI was seen in year 2 of enrollment.

Conclusions

Participation in an evidence-based wellness program was associated with improved health and experience of care. Scaling the program to larger numbers may result in an overall positive ROI.