The Application of Operations Research Methodologies to the Delivery of Care Model for Traumatic Spinal Cord Injury: The Access to Care and Timing Project

Abstract

The long-term impact of spinal cord injury (SCI) on the health care system imposes a need for greater efficiency in the use of resources and the management of care. The Access to Care and Timing (ACT) project was developed to model the health care 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. These methods have been used to solve similar problems in business and engineering and may offer a unique solution to the complexities encountered in SCI care delivery. Findings from various simulated scenarios, from the patients' point of injury to community re-integration, can be used to inform decisions on optimizing practice across the care continuum. This article describes specifically the methodology and implications of producing such simulations for the care of traumatic SCI in Canada. Future publications will report on specific practices pertaining to the access to specialized services and the timing of interventions evaluated using the ACT model. Results from this type of research will provide the evidence required to support clinical decision making, inform standards of care, and provide an opportunity to engage policymakers.

Hospital Case Volume and Outcomes among Patients Hospitalized with Severe Sepsis

“…In addition, by further depleting low-volume centers of experience caring for patients with severe sepsis, outcomes of patients developing nosocomial sepsis at the low-volume centers may deteriorate. Additional studies using simulation modeling or operations research methodologies may advance our understanding of the net effects severe sepsis care regionalization may have on patient outcomes (40).…”

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

“…Transitions between phases have been cited as a major challenge in providing optimal care for patients with tSCI and where clinicians are often constrained to working in silos [16]. The value in using a systems approach is that it enables the user to examine the potential impact(s) of interventions not just within the phase of care where it was applied (e.g.…”

“…However, we are not aware of any attempt to model the end-to-end continuum of care for a condition such as tSCI including pre-hospital, acute, rehabilitation and community phases. In 2010, we initiated the Access to Care and Timing (ACT) project, a multicentre study to model the continuum of SCI care in Canada [16]. The goals of ACT are to model the delivery of care throughout the SCI continuum; to simulate administrative, policy and therapeutic initiatives; and to predict and measure their influence on system costs and patient outcomes [16].…”

“…In 2010, we initiated the Access to Care and Timing (ACT) project, a multicentre study to model the continuum of SCI care in Canada [16]. The goals of ACT are to model the delivery of care throughout the SCI continuum; to simulate administrative, policy and therapeutic initiatives; and to predict and measure their influence on system costs and patient outcomes [16]. The objective of this paper is to describe the detailed development of a simulation model of the continuum of tSCI care for a major trauma and rehabilitation centre in Vancouver, British Columbia (BC), Canada, known as the BC ACT Model V1.0, which served as our pilot site for ACT.…”

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.…”