Assessing the impact of care pathways on potentially preventable complications and costs for spinal trauma patients: protocol for a data linkage study using cohort study and administrative data

BMJ Open, 2018 · DOI: 10.1136/bmjopen-2018-023785 · Published: September 26, 2018

Simple Explanation

This study aims to quantify the acute care costs for patients with TSCI across NSW, exploring health service pathway and clinical practice variations potentially attributable to higher cost hospitalizations. The study also intends to describe the incidence of potentially preventable complications in patients with acute TSCI and the associated incremental healthcare costs. Finally, it aims to benchmark actual patient pathways and care against best practice standards, quantifying financial costs associated with deviation of care from these standards.

Study Duration

June 2013 to June 2016

Participants

202 patients with acute TSCI

Evidence Level

Not specified

Key Findings

1
The study will accurately quantify the acute care costs for patients with TSCI across NSW, exploring health service pathway and clinical practice variations potentially attributable to higher cost hospitalisations.
2
The research will describe the incidence of potentially preventable complications in patients with acute TSCI and the associated incremental healthcare costs.
3
The study will benchmark actual patient pathways and care against the best practice standards previously defined, quantifying financial costs associated with deviation of care from these standards.

Research Summary

This study will examine a data linkage cohort of patients aged 16 years or older, who sustained acute TSCI in the Australian state of New South Wales (NSW) between June 2013 and June 2016. The Access to Care Study is a cohort study of 202 patients with TSCI, documenting early care protocols and transport decisions from the scene of injury to definitive diagnosis and specialised treatment. The study proposes to describe the costs of acute care, including those identified as attributable to potentially preventable complications. Care pathway deviations from best practice will be described, such as delayed surgery or delayed admission to SCIU for patients with TSCI.

Practical Implications

Improved resource allocation

Understanding the costs and health service drivers associated with potentially preventable complications should clarify the investment potential in the construction and implementation of a cost-effective ‘best-practice’ clinical pathway for patients with TSCI.

Establishment of standards

The study is ideally placed to establish standards, and reduce costs with potential for research translation across the state of NSW.

Clinical consequences

These findings are likely to have significant clinical consequences for the patient, cost implications for the health service and offer significant potential to make amenable recommendations for improvement.

Study Limitations

1
The costs are limited to the perspective of the healthcare provider with direct social care costs and indirect costs from loss of productivity to patients or caregivers not included, and thereby underestimate the financial impact of TSCI to the society as a whole.
2
Despite all the efforts to accurately describe all cost elements of acute care, the possibility of some resources not being captured cannot be excluded.
3
Patients with major trauma will have other immediate healthcare needs in addition to spinal cord injury management and may follow a pathway best suited to patient needs rather than the best practice pathway.

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