Date on Master's Thesis/Doctoral Dissertation

5-2023

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Health Management and Systems Sciences

Degree Program

Public Health Sciences with a specialization in Health Management, PhD

Committee Chair

Creel, Liza

Committee Co-Chair (if applicable)

Johnson, Christopher

Committee Member

Johnson, Christopher

Committee Member

Ugiliweneza, Beatrice

Committee Member

Carini, Robert

Author's Keywords

Pregnancy; spinal cord injury; paralysis; length of stay; hospitalization charges

Abstract

BACKGROUND: Spinal cord injury (SCI) results from damage to the spinal cord, leading to a temporary or permanent alteration in its normal function, usually causing a lifelong disability. SCI is one of the major causes of paralysis. Due to a sparsity of available research and to address the existing gaps, it is essential to evaluate the inpatient hospital use of pregnant women with SCI/paralysis. METHODS: This study operationalizes inpatient hospital use in three ways. We used the National (Nationwide) Inpatient Sample (NIS) from 2006 through 2019. The first analysis used a hurdle model for length of hospital stay and a linear regression for total hospitalization charges to assess non-delivery-related healthcare utilization for pregnant women with SCI/paralysis. The second analysis employed negative binomial regression for length of stay and ordinary least squares regression for total hospitalization charges to examine delivery-related healthcare utilization for pregnant women with SCI/paralysis. The third analysis used propensity-score kernel matching to determine the impact of SCI/paralysis on the healthcare utilization for inpatient encounters of pregnant women divided into groups - with and without SCI/paralysis. RESULTS: The average length of hospital stay for pregnant women with SCI/paralysis admitted for non-delivery and delivery-related reasons were 7.85 days (median: 4 days, IQR: 2 - 7 days) and 8.11 days (median: 4 days, IQR: 2 - 8 days), respectively. The average total hospitalization charges for pregnant women with SCI/paralysis admitted for non-delivery and delivery-related reasons were $85,676.47 (median: $29,181.31, IQR: $15,757.56 - $70,767.22, in 2019 dollars) and $79,027.84 (median: $30,043.4, IQR: $16,164.16 - $78,386.09, in 2019 dollars). The pregnant women with SCI/paralysis had, on average, a length of stay of about three days (SE: 0.22) longer and a total hospitalization charge of approximately $30,393.23 (SE: $24,84.01, in 2019 dollars) more than the pregnant women without SCI/paralysis. CONCLUSION: Pregnant women with SCI/paralysis have greater hospital inpatient service utilization when compared to those without SCI/paralysis. It is essential for a healthcare delivery system to understand the extent of healthcare utilization of pregnant women with SCI/paralysis to be able to develop effective programs and policies to address the needs of this population.

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