Understanding Length of Stay after Spinal Cord Injury: Insights and Limitations from the Access to Care and Timing Project

JOURNAL OF NEUROTRAUMA, 2017 · DOI: 10.1089/neu.2016.4935 · Published: October 15, 2017

Simple Explanation

The study investigates factors influencing the length of stay (LOS) in hospitals for individuals with traumatic spinal cord injuries (SCI) in Canada. It uses modeling and regression analysis to examine what drives LOS, considering variations in healthcare systems and patient characteristics. The Access to Care and Timing (ACT) project was developed to model the healthcare delivery system in Canada for patients with traumatic SCI. Techniques from operations research, such as simulation modeling, were used to predict the impact of best practices and policy initiatives on outcomes related to both the system and patients. The study highlights the importance of standardized definitions and terminology for LOS to enable accurate comparisons and benchmarking across different healthcare systems. It also emphasizes the potential of simulation modeling to assess the impact of healthcare interventions on patient flow and LOS.

Study Duration

Not specified

Participants

2893 acute, 2101 rehab, 3306 acute and rehab (Canadian data)

Evidence Level

Not specified

Key Findings

1
LOS is neither a singular nor an obvious concept, and that there is substantial variability in how it is deﬁned and determined.
2
Organizational structure and processes speciﬁc to a jurisdiction (healthcare system) can impact LOS independent of patient demographics and injury characteristics.
3
Differences in deﬁnitions can also contribute to signiﬁcant discrepancies in calculated LOS.

Research Summary

This study aimed to understand the factors contributing to the length of stay (LOS) following traumatic spinal cord injury (SCI) using modeling and regression analysis. The ACT project revealed that LOS definitions vary substantially and that healthcare system organization impacts LOS independently of patient characteristics. The study emphasizes the need for standardized LOS definitions and highlights the utility of simulation modeling for assessing healthcare interventions.

Practical Implications

Standardized Terminology

Adoption of common terminology and definitions for LOS components to facilitate comparison and benchmarking across institutions.

Healthcare System Optimization

Focus on healthcare system organization and processes to reduce LOS and improve patient flow, independent of patient characteristics.

Simulation Modeling

Utilize simulation modeling to assess the impact of healthcare interventions and policies on LOS before full implementation.

Study Limitations

1
Variability in deﬁning and determining LOS.
2
Lack of a common terminology.
3
Models will not precisely represent clinical reality, and results are dependent upon the inputs and accompanying assumptions.

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