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Furmanchuk A, Rydland KJ, Hsia RY, Mackersie R, Shi M, Hauser MW, Kho A, Bilimoria KY, Stey AM. Geographic Disparities in Re-triage Destinations Among Seriously Injured Californians. ANNALS OF SURGERY OPEN 2023; 4:e270. [PMID: 37456577 PMCID: PMC10348777 DOI: 10.1097/as9.0000000000000270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Objective To quantify geographic disparities in sub-optimal re-triage of seriously injured patients in California. Summary of Background Data Re-triage is the emergent transfer of seriously injured patients from the emergency departments of non-trauma and low-level trauma centers to, ideally, high-level trauma centers. Some patients are re-triaged to a second non-trauma or low-level trauma center (sub-optimal) instead of a high-level trauma center (optimal). Methods This was a retrospective observational cohort study of seriously injured patients, defined by an Injury Severity Score > 15, re-triaged in California (2009-2018). Re-triages within one day of presentation to the sending center were considered. The sub-optimal re-triage rate was quantified at the state, regional trauma coordinating committees (RTCC), local emergency medical service agencies, and sending center level. A generalized linear mixed-effects regression quantified the association of sub-optimality with the RTCC of the sending center. Geospatial analyses demonstrated geographic variations in sub-optimal re-triage rates and calculated alternative re-triage destinations. Results There were 8,882 re-triages of seriously injured patients and 2,680 (30.2 %) were sub-optimal. Sub-optimally re-triaged patients had 1.5 higher odds of transfer to a third short-term acute care hospital and 1.25 increased odds of re-admission within 60 days from discharge. The sub-optimal re-triage rates increased from 29.3 % in 2009 to 38.6 % in 2018. 56.0 % of non-trauma and low-level trauma centers had at least one sub-optimal re-triage. The Southwest RTCC accounted for the largest proportion (39.8 %) of all sub-optimal re-triages in California. Conclusion High population density geographic areas experienced higher sub-optimal re-triage rates.
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Affiliation(s)
- Al’ona Furmanchuk
- Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, IL
- Center for Health Information Partnerships (CHiP), Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA, Chicago, IL
| | | | - Renee Y. Hsia
- University of California San Francisco, Department of Emergency Medicine, San Francisco, CA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA
| | - Robert Mackersie
- University of California San Francisco, Department of Surgery, San Francisco, CA
| | - Meilynn Shi
- Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, IL
| | | | - Abel Kho
- Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, IL
- Center for Health Information Partnerships (CHiP), Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA, Chicago, IL
| | - Karl Y. Bilimoria
- Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, IL
| | - Anne M. Stey
- Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, IL
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Arejan RH, Azadmanjir Z, Ghodsi Z, Dehghan HR, Sharif-Alhoseini M, Tabary M, Khaleghi-Nekou M, Naghdi K, Vaccaro AR, Zafarghandi MR, Rahimi-Movaghar V. How Can Policymakers be Encouraged to Support People With Spinal Cord Injury-Scoping Review. Global Spine J 2022; 12:732-741. [PMID: 33878912 PMCID: PMC9109570 DOI: 10.1177/21925682211005406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
STUDY DESIGN Scoping review. OBJECTIVE Regarding that inappropriate medical care approaches, absence of rehabilitation services, and existing barriers in physical, social, and policy environments lead to poor outcomes in individuals with spinal cord injury (SCI) and provision for appropriate interventions and care must be created by health policymakers, we conducted this scoping review to investigate how policymakers can be persuaded to set new plans for individuals with SCI. METHODS This review was performed according to Arksey and O'Malley's framework. PubMed was searched in February2019 without language limitation. We looked for other potential gray literature sources and some professional websites. References sections of selected articles were also scanned for other relevant literature. RESULTS We included literature that met inclusion criteria to answer our research question. The literature was divided into 3 categories. The first category included economic impact of SCI. The second category included the role of research and developing research strategy. The third category included effective interaction and communication with policymakers. CONCLUSION It is essential to consider multiple factors for influencing policymakers' decisions. These factors include knowing how to communicate with policymakers and presenting constructive ideas, providing a source of valid, reliable, and consistent data, considering the role of patients' advocacy groups and Non-Governmental Organizations (NGOs), and presentation of the importance of early intervention in reducing healthcare system costs. Ultimately, the goal is to have a comprehensive and flexible plan for influencing policymakers.
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Affiliation(s)
- Roya Habibi Arejan
- Sina Trauma and Surgery Research
Center, Tehran University of Medical Sciences, Tehran, Iran
- Rehabilitation Office, State
Welfare Organization of Iran, Tehran, Iran
| | - Zahra Azadmanjir
- Sina Trauma and Surgery Research
Center, Tehran University of Medical Sciences, Tehran, Iran
- Health Information Management
Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research
Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Dehghan
- Research Center for Health
Technology Assessment and Medical Informatics, School of Public Health, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research
Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Tabary
- Experimental Medicine Research
Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Melika Khaleghi-Nekou
- Sina Trauma and Surgery Research
Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Khatereh Naghdi
- Sina Trauma and Surgery Research
Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alexander R. Vaccaro
- Department of Orthopedics and
Neurosurgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA,
USA
| | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research
Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury
Research Center, Neuroscience Institute, Tehran University of Medical Sciences,
Tehran, Iran
- Department of Neurosurgery,
Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and
Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and
Biophysics, University of Tehran, Tehran, Iran
- Spine Program, University of
Toronto, Toronto, Canada
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Young AM, Chung H, Chaplain A, Lowe JR, Wallace SJ. Development of a minimum dataset for subacute rehabilitation: a three-round e-Delphi consensus study. BMJ Open 2022; 12:e058725. [PMID: 35338067 PMCID: PMC8961134 DOI: 10.1136/bmjopen-2021-058725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/01/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To develop a minimum dataset to be routinely collected across a heterogenous population within a subacute rehabilitation service to guide best care and outcomes for patients, and value for the health service. DESIGN Three-round e-Delphi exercise, followed by consensus meetings. SETTING Multicentre study in Brisbane, Australia. PARTICIPANTS Rehabilitation decision-makers, researchers and clinicians were invited to participate in the e-Delphi exercise. A multidisciplinary project steering committee (rehabilitation decision makers, researchers, clinicians and consumers) participated in consensus meetings. METHODS In round 1 of the e-Delphi, participants responded to an open-ended question, generating data and outcomes that should be routinely collected in rehabilitation. In rounds 2 and 3, participants rated the importance of collecting each item on a nine-point scale. Consensus was defined a priori, as items rated as 'essential' by at least 70%, and of 'limited importance' by less than 15%, of respondents. Consensus meetings were held to further refine and define the dataset for implementation. RESULTS In total, 38 participants completed round 1 of the e-Delphi. Qualitative content analysis of their responses generated 1072 codes, which were condensed into 39 categories and 209 subcategories. Following two rounds of rating (round 2: n=32 participants; round 3: n=28 participants), consensus was reached for 124 items. Four consensus meetings (n=14 participants) resulted in the final dataset which included 42 items across six domains: (1) patient demographics, (2) premorbid health and psychosocial information, (3) admission information, (4) service delivery and interventions, (5) outcomes and (6) caregiver information and outcomes. CONCLUSIONS We identified 42 items that reflect the values and experiences of rehabilitation stakeholders. Items unique to this dataset include caregiver information and outcomes, and detailed service delivery and intervention data. Future research will establish the feasibility of collection in practice.
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Affiliation(s)
- Adrienne M Young
- Allied Health Professions, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Herston, Queensland, Australia
| | - Hannah Chung
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Alicia Chaplain
- Allied Health Professions, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Joshua R Lowe
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Queensland, Australia
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Stey AM, Wybourn CA, Lyndon A, Knudson MM, Dudley RA, Liu P, Bongiovanni T, Ryan GW. How care decisions are made among interdisciplinary providers caring for critically injured patients: A qualitative study. Surgery 2019; 167:335-339. [PMID: 31843221 DOI: 10.1016/j.surg.2019.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 09/26/2019] [Accepted: 11/03/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Injury is the leading cause of death in people under 45 years of age in the United States; however, how care decisions occur in critical injury is poorly understood. This exploratory study sought to generate hypotheses about how care decisions are made among interdisciplinary providers caring for patients who have been critically injured. METHODS This was a qualitative study conducted at two intensive care units in a level 1 trauma center in an urban, teaching, safety-net hospital. Semistructured interviews consisted of case scenarios with competing clinical priorities presented to 25 interdisciplinary providers, elucidating how decisions are approached. Responses were recorded, transcribed, and coded. Thematic analysis was conducted to discover central themes. Category formulation and sorting was done for data reduction and thematic structuring of the data. The range and central tendency of these themes are reported. RESULTS The central theme for how care decisions are made among interdisciplinary providers was through the distribution of shared responsibility. The distribution of shared responsibility depended on interdisciplinary communication to navigate the two subthemes of time and roles. Time had to be navigated carefully, because it was both an opportunity for data acquisition and consensus building but also a pressure to decisively progress care. Roles were distinct but interchangeable and consisted of experts, actualizers, and questioners. CONCLUSION Care decisions are made in the context of shared responsibility among interdisciplinary providers. Interdisciplinary communication is a means of establishing roles and navigating time to distribute shared responsibility among interdisciplinary providers.
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Affiliation(s)
- Anne M Stey
- Northwestern University, Chicago, IL; University of California San Francisco, San Francisco, CA.
| | | | - Audrey Lyndon
- University of California San Francisco, San Francisco, CA; NYU Rory Meyers College of Nursing, New York, NY
| | | | - R Adams Dudley
- University of California San Francisco, San Francisco, CA
| | - Pingyang Liu
- University of California San Francisco, San Francisco, CA
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Vaikuntam BP, Middleton JW, McElduff P, Pearse J, Walsh J, Cameron ID, Sharwood LN. 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; 8:e023785. [PMID: 30413515 PMCID: PMC6231591 DOI: 10.1136/bmjopen-2018-023785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Traumatic spinal cord injuries have significant consequences both for the injured individual and the healthcare system, usually resulting in lifelong disability. Evidence has shown that timely medical and surgical interventions can lead to better patient outcomes with implicit cost savings. Potentially preventable secondary complications are therefore indicators of the effectiveness of acute care following traumatic injury. The extent to which policy and clinical variation within the healthcare service impact on outcomes and acute care costs for patients with traumatic spinal cord injury (TSCI) in Australia is not well described. METHODS AND ANALYSIS A comprehensive data set will be formed using record linkage to combine patient health and administrative records from seven minimum data collections (including costs), with an existing data set of patients with acute TSCI (Access to Care Study), for the time period June 2013 to June 2016. This person-level data set will be analysed to estimate the acute care treatment costs of TSCI in New South Wales, extrapolated nationally. Subgroup analyses will describe the associated costs of secondary complications and regression analysis will identify drivers of higher treatment costs. Mapping patient care and health service pathways of these patients will enable measurement of deviations from best practice care standards and cost-effectiveness analyses of the different pathways. ETHICS AND DISSEMINATION Ethics approval has been obtained from the New South Wales Population and Health Services Research Ethics Committee. Dissemination strategies include peer-reviewed publications in scientific journals and conference presentations to enable translation of study findings to clinical and policy audiences.
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Affiliation(s)
- Bharat Phani Vaikuntam
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, John Walsh Centre for Rehabilitation Research, Sydney, New South Wales, Australia
| | - James W Middleton
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, John Walsh Centre for Rehabilitation Research, Sydney, New South Wales, Australia
- Agency for Clinical Innovation, NSW Statewide Spinal Cord Injury Service, Sydney, New South Wales, Australia
| | | | - Jim Pearse
- Health Policy Analysis, Sydney, New South Wales, Australia
| | - John Walsh
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, John Walsh Centre for Rehabilitation Research, Sydney, New South Wales, Australia
| | - Ian D Cameron
- Kolling Institute, John Walsh Centre for Rehabilitation Research, Sydney, New South Wales, Australia
| | - Lisa Nicole Sharwood
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, John Walsh Centre for Rehabilitation Research, Sydney, New South Wales, Australia
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Fehlings MG, Cheng CL, Chan E, Thorogood NP, Noonan VK, Ahn H, Bailey CS, Singh A, Dvorak MF. Using Evidence To Inform Practice and Policy To Enhance the Quality of Care for Persons with Traumatic Spinal Cord Injury. J Neurotrauma 2017; 34:2934-2940. [PMID: 28566019 PMCID: PMC5652974 DOI: 10.1089/neu.2016.4938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In today's economic climate, there is a need to demonstrate a return on investment for healthcare spending and for clinical practice and policy to be informed by evidence. Navigating this process is difficult for decision-makers, clinicians, and researchers alike. This article will describe how a knowledge translation framework and an evidence-based policy-making process were integrated to clarify the problem, frame options, and plan implementation, to impact clinical practice and policy in the area of traumatic spinal cord injury (tSCI). The Access to Care and Timing (ACT) project is focused on optimizing the access and timing of specialized healthcare delivery for persons sustaining a tSCI in Canada. A simulation model was developed that uses current patient data to address complex problems faced by the healthcare system. At a workshop, participants stressed the importance of linking interventions to short- and long-term outcomes to drive change. Presently, there are no national, system level indicators to monitor performance after tSCI. Although the ideal system of care after tSCI is unknown, indicator collection will establish a baseline to measure improvement. The workshop participants prioritized two indicators important from the clinician and patient perspective-timely admission to rehabilitation and meaningful community participation. The ACT simulation model for tSCI care will be used to promote the uptake of identified indicators and provide a predictive link between interventions on potential outcomes. The standardized collection of outcome-oriented indicators will help to evaluate the access and timing of care and to define the ideal system of care after SCI.
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Affiliation(s)
| | | | - Elaine Chan
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | | | | | - Henry Ahn
- University of Toronto Spine Program, Toronto, Ontario, Canada
| | - Christopher S. Bailey
- Division of Orthopaedics, Department of Surgery, Western University, London, Ontario, Canada
| | - Anoushka Singh
- SCI Clinical Research Unit, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marcel F. Dvorak
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Röthlisberger F, Boes S, Rubinelli S, Schmitt K, Scheel-Sailer A. Challenges and potential improvements in the admission process of patients with spinal cord injury in a specialized rehabilitation clinic - an interview based qualitative study of an interdisciplinary team. BMC Health Serv Res 2017. [PMID: 28651583 PMCID: PMC5485498 DOI: 10.1186/s12913-017-2399-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The admission process of patients to a hospital is the starting point for inpatient services. In order to optimize the quality of the health services provision, one needs a good understanding of the patient admission workflow in a clinic. The aim of this study was to identify challenges and potential improvements in the admission process of spinal cord injury patients at a specialized rehabilitation clinic from the perspective of an interdisciplinary team of health professionals. Methods Semi-structured interviews with eight health professionals (medical doctors, physical therapists, occupational therapists, nurses) at the Swiss Paraplegic Centre (acute and rehabilitation clinic) were conducted based on a maximum variety purposive sampling strategy. The interviews were analyzed using a thematic analysis approach. Results The interviewees described the challenges and potential improvements in this admission process, focusing on five themes. First, the characteristics of the patient with his/her health condition and personality and his/her family influence different areas in the admission process. Improvements in the exchange of information between the hospital and the patient could speed up and simplify the admission process. In addition, challenges and potential improvements were found concerning the rehabilitation planning, the organization of the admission process and the interdisciplinary work. Conclusion This study identified five themes of challenges and potential improvements in the admission process of spinal cord injury patients at a specialized rehabilitation clinic. When planning adaptations of process steps in one of the areas, awareness of effects in other fields is necessary. Improved pre-admission information would be a first important step to optimize the admission process. A common IT-system providing an interdisciplinary overview and possibilities for interdisciplinary exchange would support the management of the admission process. Managers of other hospitals can supplement the results of this study with their own process analyses, to improve their own patient admission processes. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2399-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fabian Röthlisberger
- Swiss Paraplegic Centre (SPC), Guido Zäch Strasse 1, 6207, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland.,Inselspital Bern, 3010, Berne, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland.,Swiss Paraplegic Research (SPF), Guido Zäch Strasse 4, 6207, Nottwil, Switzerland
| | - Klaus Schmitt
- Swiss Paraplegic Centre (SPC), Guido Zäch Strasse 1, 6207, Nottwil, Switzerland.,Swiss Paraplegic Centre, Corporate Development, Guido Zäch Strasse 1, 6207, Nottwil, Switzerland
| | - Anke Scheel-Sailer
- Swiss Paraplegic Centre (SPC), Guido Zäch Strasse 1, 6207, Nottwil, Switzerland. .,Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland.
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