United States Veterans’ utilization of spinal cord injuries and disorders annual evaluation services

Abstract: Objective: To evaluate Veterans’ engagement in Spinal Cord Injuries and Disorders (SCI/D) specialty annual evaluations. Design: Cross-sectional retrospective cohort study Setting: (SCI/D System of Care, United States Department of Veterans Affairs (VA). Participants: 14,662 Veterans with SCI/D. Interventions: N/A. Main Outcome Measures: Receiving SCI/D annual evaluations (AEs) during the study period (fiscal years 2019 and 2020) Results: A total of 14,662 Veterans with SCI/D were included in the sample; 32.8% (n=4,811) received two AEs; 28.8% (n=4,219) received one AE, and 38.4% (n=5,632) received zero AEs with an average of 0.9 AEs per Veterans over the 2-year study timeframe (range: 0-2). Black Veterans had 8% higher numbers of AEs compared to white Veterans after adjusting for other variables (adjusted RR: 1.08, 95%CI: 1.04 – 1.12). Veterans who lived 240 minutes or more away from a VA SCI/D System of Care Center had 45% less AEs compared to Veterans who lived within 30 minutes (Adjusted RR: 0.55, 95% CI: 0.52 – 0.59). Veterans with more SCI/D specialty visits had 90% more AEs compared to those with less, (Adjusted RR: 1.90, 95% CI: 1.78 – 2.03), while Veterans with more outpatient visits in VA primary care had 28% fewer AEs (Adjusted RR: 0.72, 95% CI: 0.69 – 0.76). Veterans with higher co-morbidity scores had 9% more AEs compared to Veterans with lower scores (Adjusted RR: 0.66, 95% CI: 0.61 – 0.70). Conclusions: Over half (62%) of Veterans received at least one SCI/D AE during FY19-FY20. Veterans living closer to a VA SCI/D System of Care Centers/Hubs had more engagement in SCI/D AEs. Veterans with SCI/D who used VA primary care outside of the SCI/D System of Care, had less AEs. There were no major racial, age-based, or gender disparities in SCI/D AE utilization. Our findings suggest the need for targeted intervention efforts to promote AE use among Veterans.