Increasing External Pressures Affecting Patient’s Quality of Life
Spinal cord injuries (SCI) are catastrophic injuries that have permanently altered the lives of 282,000 U.S. citizens. The consequences are far-reaching, causing subsequent paralysis, limited mobility, and secondary complications. These patients require time in rehabilitation centers to physically recover, psychologically adjust to their new state, and education in how to cope with these permanent changes.
Unfortunately, the health care industry is trending to reduce length of stay to cut costs, shortening rehabilitation length of stays from 98 days in the 1970s to 35 days today; this trend reduces the crucial time needed by patients to better manage their newfound disability and it increases the risks of secondary complications. Approximately 30% of SCI patients are re-hospitalized one or more times in the year following their injury, wherein urinary tract infections and pressure ulcers are the leading causes. These rehospitalizations are costly to all parties and possibly fatal for patients. Hospitals incur an average of $43,180 for each ulcer and these ulcers cause 17,000 lawsuits to be filed against hospitals annually. On the patient side, pressure ulcers cause 7 – 8% deaths of those of SCI patients.
Secondary conditions, such as pressure ulcers, are often preventable with the proper care, but it is difficult for SCI patients with low income or those living in rural areas to receive this specialized medical care. Given the limited amount of organizations that have rehabilitation specialists, the commute for some rural disabled patients could take hours. Due to the time commitment, financial pressure, lack of mobility, and/or inflexible work hours, vulnerable patients are likely to delay diagnosis and treatment, further exacerbating the likelihood of secondary complications.
Remediating the Cost and Reach Issues with Telemedicine
To deal with the issues stated above, for decades the Santa Clara Valley Medical Center sent their SCI specialist out to rural areas 8-10 times a year to conduct outpatient clinics across Northern and Central California. While this solution did provide relief for many patients, it is far from ideal. There are still issues regarding the infrequency of access, general lack of flexibility, and the costs of sending medical teams across California.
Recently, SCVMC has been exploring the possibilities of using telemedicine to address the shortcomings of their historic approach to the problem. By utilizing consumer technology, SCVMC is exploring the possibilities of managing secondary complications and improving overall quality of life (QoL) for individuals with SCI. There has been prior research that showed positive results in reducing stage II and stage IV ulcers when incorporating telemedicine to increase accessibility to patients (particularly those in rural areas).
SCVMC began a study by supplying a small group of individuals with iPads and showing them how to schedule an appointment and have a live consultation via FaceTime; this research was the first known project to utilize iPads as a telemedicine entry-point. The 6-month study concluded with a high patient satisfaction rate and enabled a more accessible method to transfer important information regarding the complications of living with SCI to patients. The hospital’s research suggests that there is a feasibility when using these types of tools to increase patient QoL and ideally these findings can be expanded to other areas in medicine.
Although the findings were positive, SCVMC has not publicly announced any definitive plans for the medium-term yet. This is understandable given the nature of the healthcare industry; any incremental changes to patient care needs to be meticulously studied and approached with caution.
Further Suggestions for SCVMC Rehab Center
I fundamentally agree that there is significant value to be added in advancing patient care by digitally connected patients directly to the hospital’s resources. I believe they can catalyze this change by focusing on the cost benefits. The current research SCVMC has done is focused on patient QoL, and while that is extremely important, there can be a larger push for change by the entire organization if their research stated the financial aspects of telemedicine.
By utilizing time-driven activity-based costing on preventable rehospitalizations, the hospital can have a better side-by-side comparison of the cost difference between telemedicine and the status quo. SCVMC should undertake a longitudinal study that shows the difference in absolute costs due to the decreases in secondary complications.
Given the greater accessibility and decreased variability for patients access to their doctors, they should also study telemedicine’s effect on missed appointments (which is estimated to cost the U.S. healthcare system $150 billion a year).
By moving appointments from in-person to online, how will SCVMC ensure that these consultations achieve parity in quality?
Should this program be widely available for all patients, or those that have exceptional difficulties reaching the hospital?
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 National SCI Statistical Center, “Spinal Cord Injury (SCI) Facts and Figures at a Glance”, https://www.nscisc.uab.edu/Public/Facts%202016.pdf, accessed November 2017.
 Phillips, V. L, “Telehealth: Reaching Out to Newly Injured Spinal Cord Patients” in Public Health Reports 2001 Supplement 1, http://journals.sagepub.com/doi/pdf/10.1093/phr/116.S1.94, accessed November 2017.
 Agency for Healthcare Research and Quality, “Preventing Pressure Ulcers in Hospitals”, https://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/putool1.html, accessed November 2017.
 Shem, Kazuko and Sechrist, Samantha, “SCiPad: Effective Implementation of Telemedicine Using iPads with Individuals with Spinal Cord Injuries, a Case Series”, May 29, 2017, https://www.frontiersin.org/articles/10.3389/fmed.2017.00058/full, accessed November 2017.
 Beatty PW, Hagglund KJ, Neri MT, Dhont KR, Clark MJ, Hilston SA, “Access to health care services among people with chronic or disabling conditions: patterns and predictors”, Arch Phys Med Rehabil (2003), http://www.sciencedirect.com/science/article/pii/S0003999303002685, accessed November 2017.
 Smith MW, Hill ML, Hopkins KL, Kiralti BJ, Cronkite RC, “A modeled analysis of telehealth methods for treating pressure ulcers after spinal cord injury. Int J Telemed Appl (2012), https://www.hindawi.com/journals/ijta/2012/729492/, accessed November 2017.
 Zimmerman, Scott, “Insight: Tackling healthcare’s costly problem of missed appointments”, Healthcare Finance, April 24, 2015, http://www.healthcarefinancenews.com/blog/insight-tackling-healthcares-costly-problem-missed-appointments, accessed November 2017.