Access to Care and Timing (ACT)

Project number: 
15-119
Approval date: 
Thursday, March 23, 2017
Principal Investigator: 
Dvorak,Marcel
Institution: 
Vancouver General Hospital (VGH)
Funding Agency: 
Not Available
Datasets requested: 
Not available
Research objective: 

The primary objective of ACT/I is to develop a health care delivery model of the provision of pre-hospital, acute and rehabilitation services for people with traumatic SCI, in order to evaluate the timeliness and location of care delivery and how they relate to outcomes. The secondary objective is to utilize the health care delivery model to examine aspects of care delivery (Clinical Practice Guidelines related to setting and timing of interventions) and the associated patient and system-level outcomes. Several areas of interest for the project have been identified through consultation with subject-matter experts. The following is a list of hypotheses relating to those areas.

1. Pre-Hospital Setting
Hypothesis 1: Patients who are recognized as having an acute traumatic SCI at the scene of the injury by the first responding ambulance crew will have better patient outcomes (lower mortality, greater patient satisfaction, less neurological impairment and higher levels of function) and have lower heath care costs (fewer complications, shorter total length of stay (LOS), improved resource utilization, lower total cost) if they are taken directly to a specialized spinal cord centre compared to patients taken to a regional hospital or regional trauma centre.

2. Acute Setting
Hypothesis 2: Patients with an acute traumatic SCI that are treated in an acute SCI centre that cohorts SCI patients will have better patient outcomes (fewer complications, greater patient satisfaction, and possibly less neurological impairment and higher levels of function) and lower health care costs (fewer complications, shorter acute LOS, improved resource utilization, lower total cost) compared to patients that are treated in centres where patients are not cohorted.

3. Rehabilitation Setting
Hypothesis 3: Patients with an acute traumatic SCI that are treated in a rehabilitation centre that cohorts SCI patients will have better patient outcomes (fewer complications, greater patient satisfaction, and possibly less neurological impairment and higher levels of function) and lower health care costs (fewer complications, shorter rehab LOS, improved resource utilization, lower total cost) compared to patients that are treated in centres where patients are not cohorted.

Hypothesis 4: Patients with an acute traumatic SCI that are treated in a program where acute and rehabilitation services are integrated will have better patient outcomes (greater patient satisfaction, and possibly less neurological impairment and higher levels of function) and lower health care costs (fewer complications, shorter total LOS, improved resource utilization, lower total cost) compared to patients that are treated in centres where patients are in separate facilities.

4. Timing of Surgery
Hypothesis 5: Patients with an acute traumatic SCI who receive surgery early (e.g. within 8 to 24 hours) following injury will have better patient outcomes (fewer complications, greater patient satisfaction, less neurological impairment and higher levels of function) and lower health care costs (fewer complications, shorter LOS, improved resource utilization, lower total costs compared to patients that receive surgery more than 24 hours following injury (experience delays).

5. Timing of Rehabilitation
Hypothesis 6: Patients with an acute traumatic SCI that receive early intensive/comprehensive rehabilitation (e.g. early physiatry consult, no ALC days at acute) will have better patient outcomes (fewer complications, greater patient satisfaction, and possibly less neurological impairment and higher levels of function) and lower health care costs (fewer complications, shorter total LOS, improved resource utilization, lower total cost) compared to patients that experience delays in receiving intensive/comprehensive rehabilitation.

6. Complications
Hypothesis 7: Patients with an acute traumatic SCI who experience minimal or no complications during the acute and rehabilitation care will have improved patient outcomes (lower mortality, improved patient satisfaction, and possibly less neurological impairment and higher levels of function) and lower health care costs (decreased LOS, fewer re-admissions, lower treatment costs) compared with patients who experience multiple complications.


Page last revised: May 2, 2017