The ACT Focus Issue is a collaboration of more than 50 researchers and clinicians across Canada. Published in the prestigious Journal of Neurotrauma, the Focus Issue contains 13 peer-reviewed articles based on the ACT project and uses clinical and demographic data collected from individuals who participate in the Rick Hansen SCI Registry. All articles are freely available on the journal's website.
This work is an important theme in RHI's Care Program which aims to provide equitable care for all Canadians with SCI.
Below are some key questions the Focus Issue addresses (click on the questions to find the answer):
What level of care can Canadians with traumatic SCI expect to receive at SCI-specialized hospitals?
Based on a review of 26 acute and rehabilitation hospitals in 8 Canadian provinces, results revealed similarities in the basic structure and provision of general services (e.g. having spine surgeon on call 24/7 and physiatry consultation in acute centres), but also some differences in the degree of specialization of care for the traumatic SCI patient population (e.g. rehabilitation admission criteria). Future research is needed to examine the impact of specialized care for both the patient and healthcare system.
Does it matter where you get injured? How does it impact the care you receive?
Yes, the closer you are to a specialized acute hospital when injured, the more likely the ambulance will send you directly to that hospital to receive specialized care sooner. Patients who are older and injured slightly farther away, are more likely to be sent to a non-specialized hospital before being transferred to a specialized hospital. These individuals don't get specialized care until an average of 7 hours later. This is important as quick access to specialized care is key to better recovery. This study supports further research into factors that influence medical response protocols in the hours following injury.
Geomapping of traumatic spinal cord injury admitted to Rick Hansen SCI Registry acute facilities in 2010-2013
Is the reporting of hospitalization (length of stay (LOS)) the same across Canada?
No, surprisingly, there is considerable variation in the definitions and methods used to determine LOS following SCI in different jurisdictions. There are also many factors that influence how long a patient will stay in a hospital after injury. To optimize healthcare system efficiencies, future research is required to identify and improve understanding of what factors contribute to LOS. Work in this area will be facilitated by the adoption of common terminology and definitions, as well as the use of simulations and modeling.
Does specialized rehabilitation improve the chances of returning home after traumatic SCI?
Yes, our data shows that people who receive specialized rehabilitation as part of inpatient treatment are six times more likely to return home after hospitalization. Those who do not get specialized rehabilitation are more likely to live in a nursing home or places other than home after the injury. Many other factors can influence whether people return home after SCI, and these factors require further investigation.
What if patients with SCI receive the same amount of inpatient rehabilitation therapy but in a shorter time?
In a hypothetical situation, patients recover their motor function faster and finish their rehabilitation program sooner if the therapy intensity is increased. This also implies that there is potential for reduced resource utilization and increased cost savings. The results highlight the importance of monitoring patients' recovery progress and the need for different strategies for patients who are not progressing through standard therapy.
How does living in rural setting compare to urban settings after SCI?
Based on data from one province (BC) so far, our results suggest that people living in rural and urban settings face similar challenges in terms of accessibility and health after SCI. The results also revealed that individuals living in an urban setting were more likely to report depression. Future research should expand to other provinces for their rural and urban trends.
How can secondary complications after SCI be mitigated?
We found that certain patients are more likely to develop secondary complications after SCI. These patients are often older, are more severely injured, have psychiatric conditions and issues with substance abuse or withdrawal. More research is needed to validate these results, but by knowing who are more at risk in developing secondary complications after SCI, we can proactively pay closer attention to these patients and prevent secondary complications from developing or worsening.
How costly are hospital-acquired pressure injuries (PI) and urinary tract infections (UTI)?
PI and UTI are two of the more common secondary complications that can occur within the days and weeks after a SCI. Even a relatively minor UTI or PI added approximately $8,000 and $19,000 (2013 CAD) respectively, to the direct cost of acute SCI admission. For health economists and researchers, this information will facilitate comparative economic analyses and decision analytic modeling in SCI to help make healthcare decisions informed by evidence.
What financial resources are required for future traumatic SCI care needs?
Our general population is aging and people who get injured are also getting older. The number of people age 60 and older getting injured will double, costing the healthcare system an additional of $16.4 million (CAD) by 2032 due to the complex medical conditions with advancing age. Prevention and awareness will be key to battle the imminent increase in traumatic SCI.
How can SCI care be improved?
Research has come a long way in improving SCI care but knowledge gaps still exist. Gaps include lack of accurate information on injury severity, protocols and costs, and lack of connection throughout the SCI care continuum (prehospital, acute, rehab, and community), which prevents a comprehensive understanding of healthcare system performance. Addressing these gaps will further improve standards of care. Some recommendations to reduce these gaps are to standardize data element collection and facilitate database linkages; validate and adopt more outcome measures for SCI and; increase opportunities for collaboration with stakeholders from diverse backgrounds.
What can we, the Canadian SCI Network, do to enhance the quality of traumatic SCI care?
There is national consensus from the Canadian SCI Network to collect national, system level indicators to monitor performance of healthcare system for SCI care. Collecting indicators (e.g. time from injury to rehabilitation admission, meaningful community participation) can help establish a baseline to measure improvement and evaluate the access and timing of care for people with traumatic SCI.