Secondary Complications in SCI Across the Continuum: Using Operations Research to Predict the Impact and Optimize Management Strategies

Abstract

Secondary complications following traumatic spinal cord injury (tSCI) have a tremendous impact on quality of life and health care costs. Although some complications result from the injury itself, many originate from the care provided; complications arising early in the tSCI journey can predispose an individual to recurrence later. To measure the total impact of secondary complications on patient outcomes and health care costs, all the stages of care, from first response to life in the community, must be spanned. Interventions to ameliorate secondary complications need to consider the effects on the whole system and not just individual phases of care; however, such an approach is not common in the literature. To measure the impact of complications as well as the effect of proposed interventions, a partnership between clinical researchers and operations research professionals was formed to develop a discrete-event simulation model of the entire continuum of tSCI care. In this article, we focus on the part of the model concerning common secondary complications (eg, pressure ulcers, pneumonia). We first describe early results from the model, discuss how the effects from the complications impact care throughout the tSCI continuum, and review assumptions of the model. The article concludes with a discussion as to the possible uses of the model, their strengths/limitations, and future directions.

International survey of perceived barriers to admission and discharge from spinal cord injury rehabilitation units

“…Recent publications using the operations research methodology have highlighted the opportunities for improving these internal processes for patients with SCI. 28,29 CONCLUSIONS We have found that many SRUs have problems with timely access for acute hospital patients to their beds and most have problems with barriers to discharge. These problems contribute to hospital inefficiency and compromise patient outcomes.…”

The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study

“…The Access to Care and Timing (ACT) simulation model for SCI care, 103,104 described in the current focus issue, 105 is one example of a decision analytic model that allows for comparative analyses of interventions in one phase of care on the entire continuum of care. The results of the case series and discussion will support application of the ACT model to access possible solutions to the burden of UTI and PU in the traumatic SCI population.…”

Model for bridging the translational "valleys of death" in spinal cord injury research

“…Using data gathered through the RHSCIR, a simulation model of the continuum of care for patients with traumatic SCI was created as a novel approach to look at the access and timing of care for traumatic SCI in Canada. 43 This model will be used to evaluate the impact of new policy initiatives on patient and system outcomes, and allows RHI researchers to test different strategies for management and treatment of pressure ulcers to estimate outcomes based on certain interventions. 43 The results of these simulations will be valuable when analyzing the direct and indirect effects of pressure ulcer initiatives throughout the care continuum and optimizing future decisions for people with traumatic SCI.…”