Modeling the Patient Journey from Injury to Community Reintegration for Persons with Acute Traumatic Spinal Cord Injury in a Canadian Centre

PLoS ONE, 2013 · DOI: 10.1371/journal.pone.0072552 · Published: August 30, 2013

Spinal Cord Injury Healthcare Research Methodology & Design

Simple Explanation

This paper describes the development of a simulation model, the BC ACT Model V1.0, that maps the journey of patients with traumatic spinal cord injuries (tSCI) through the healthcare system in British Columbia, Canada. The model tracks patients from the point of injury through acute care and rehabilitation, all the way to community reintegration, simulating the impact of various clinical and administrative interventions along the way. By creating this model, researchers aim to provide a tool for clinicians and decision-makers to evaluate the potential effects of different strategies on patient outcomes and system efficiency.

Study Duration

April 2004 and July 2009

Participants

532 patients with traumatic SCI

Evidence Level

Not specified

Key Findings

1
The simulation model can estimate the impact of interventions, showing both direct and indirect effects across the continuum of care.
2
A scenario analysis showed that reducing pressure ulcer incidence by 70% could decrease acute and rehabilitation length of stay by 4 and 2 days, respectively.
3
The model demonstrated that early surgery for cervical injuries could improve neurological recovery, increase life expectancy, and reduce lifetime costs.

Research Summary

The BC ACT Model V1.0 was developed using discrete-event simulation to evaluate the impact of clinical and administrative interventions along the entire tSCI continuum of care. The model incorporates data from the Rick Hansen Spinal Cord Injury Registry, literature reviews, subject matter experts, and other data sources to simulate patient flow and outcomes. Scenario analyses demonstrate the model's flexibility and value as a decision-making tool, providing estimates of the effects of different interventions and allowing them to be objectively compared.

Practical Implications

Improved Decision-Making

The model provides clinicians and administrators with a tool to evaluate the potential impact of interventions on patient outcomes and system efficiency.

Resource Allocation

The model can inform decisions about resource allocation, such as the number of rehabilitation beds needed to reduce wait times in acute care.

Identifying Best Practices

The model can help identify best practices across the SCI continuum of care by comparing different care delivery models.

Study Limitations

1
Full model validation using DES methods is an ongoing process and can be very time consuming and data intensive.
2
The low incidence of tSCI and the extremely large variability between cases makes it difficult to obtain adequate data.
3
There is limited published evidence for the predisposition towards the recurrence of secondary complications.

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