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The application of operations research methodologies to the delivery of care model for traumatic spinal cord injury: the access to care and timing project.

https://arctichealth.org/en/permalink/ahliterature122592
Source
J Neurotrauma. 2012 Sep;29(13):2272-82
Publication Type
Article
Date
Sep-2012
Author
Vanessa K Noonan
Lesley Soril
Derek Atkins
Rachel Lewis
Argelio Santos
Michael G Fehlings
Anthony S Burns
Anoushka Singh
Marcel F Dvorak
Author Affiliation
Rick Hansen Institute, Vancouver, British Columbia, Canada.
Source
J Neurotrauma. 2012 Sep;29(13):2272-82
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Emergency Medical Services - organization & administration - trends
Health Services Accessibility - organization & administration - trends
Humans
Models, organizational
National Health Programs - organization & administration - trends
Outcome Assessment (Health Care) - methods - organization & administration
Quality of Health Care - organization & administration - trends
Spinal Cord Injuries - economics - mortality - rehabilitation
Trauma Centers - organization & administration - standards - trends
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.
Notes
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PubMed ID
22800432 View in PubMed
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Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America Myelopathy study.

https://arctichealth.org/en/permalink/ahliterature107913
Source
Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S161-70
Publication Type
Article
Date
Oct-15-2013
Author
Justin S Smith
Virginie Lafage
Devon J Ryan
Christopher I Shaffrey
Frank J Schwab
Alpesh A Patel
Darrel S Brodke
Paul M Arnold
K Daniel Riew
Vincent C Traynelis
Kris Radcliff
Alexander R Vaccaro
Michael G Fehlings
Christopher P Ames
Author Affiliation
*Department of Neurosurgery, University of Virginia, Charlottesville †Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York ‡Department of Orthopaedic Surgery, Northwestern University, Chicago, IL §Department of Orthopaedic Surgery, University of Utah, Salt Lake City ¶Department of Neurosurgery, University of Kansas, Kansas City ?Department of Orthopaedic Surgery, Washington University, St Louis, MO **Department of Neurosurgery, Rush Medical Center, Chicago, IL ††Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA ‡‡Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, Ontario, Canada; and §§Department of Neurological Surgery, University of California, San Francisco.
Source
Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S161-70
Date
Oct-15-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Cervical Vertebrae - radiography - surgery
Female
Humans
Kyphosis - radiography - surgery
Magnetic Resonance Imaging - methods
Male
Middle Aged
Preoperative Period
Prospective Studies
Quality of Life
Spinal Cord - radiography - surgery
Spinal Cord Diseases - radiography - surgery
Spondylosis - radiography - surgery
Treatment Outcome
United States
Abstract
Post hoc analysis of prospectively collected data.
Development of methods to determine in vivo spinal cord dimensions and application to correlate preoperative alignment, myelopathy, and health-related quality-of-life scores in patients with cervical spondylotic myelopathy (CSM).
CSM is the leading cause of spinal cord dysfunction. The association between cervical alignment, sagittal balance, and myelopathy has not been well characterized.
This was a post hoc analysis of the prospective, multicenter AOSpine North America CSM study. Inclusion criteria for this study required preoperative cervical magnetic resonance imaging (MRI) and neutral sagittal cervical radiography. Techniques for MRI assessment of spinal cord dimensions were developed. Correlations between imaging and health-related quality-of-life scores were assessed.
Fifty-six patients met inclusion criteria (mean age = 55.4 yr). The modified Japanese Orthopedic Association (mJOA) scores correlated with C2-C7 sagittal vertical axis (SVA) (r = -0.282, P = 0.035). Spinal cord volume correlated with cord length (r = 0.472, P
PubMed ID
23963001 View in PubMed
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The combined use of surgery and radiotherapy to treat patients with epidural cord compression due to metastatic disease: a cost-utility analysis.

https://arctichealth.org/en/permalink/ahliterature125207
Source
Neuro Oncol. 2012 May;14(5):631-40
Publication Type
Article
Date
May-2012
Author
Julio C Furlan
Kelvin K-W Chan
Guillermo A Sandoval
Kenneth C K Lam
Christopher A Klinger
Roy A Patchell
Audrey Laporte
Michael G Fehlings
Author Affiliation
Division of Genetics and Development, Toronto Western Research Institute, Krembil Neuroscience Centre, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada M5T 2S8. jcfurlan@gmail.com
Source
Neuro Oncol. 2012 May;14(5):631-40
Date
May-2012
Language
English
Publication Type
Article
Keywords
Combined Modality Therapy
Computer simulation
Cost-Benefit Analysis
Decision Support Techniques
Epidural Neoplasms - economics - secondary - therapy
Health Care Costs
Humans
Long-Term Care
Monte Carlo Method
Neurosurgical Procedures - economics - utilization
Ontario
Prognosis
Quality-Adjusted Life Years
Radiotherapy - economics - utilization
Spinal Cord Compression - economics - therapy
Abstract
Neoplastic metastatic epidural spinal cord compression is a common complication of cancer that causes pain and progressive neurologic impairment. The previous standard treatment for this condition involved corticosteroids and radiotherapy (RT). Direct decompressive surgery with postoperative radiotherapy (S + RT) is now increasingly being chosen by clinicians to significantly improve patients' ability to walk and reduce their need for opioid analgesics and corticosteroids. A cost-utility analysis was conducted to compare S + RT with RT alone based on the landmark randomized clinical trial by Patchell et al. (2005). It was performed from the perspective of the Ontario Ministry of Health and Long-Term Care. Ontario-based costs were adjusted to 2010 US dollars. S + RT is more costly but also more effective than corticosteroids and RT alone, with an incremental cost-effectiveness ratio of US$250 307 per quality-adjusted life year (QALY) gained. First order probabilistic sensitivity analysis revealed that the probability of S + RT being cost-effective is 18.11%. The cost-effectiveness acceptability curve showed that there is a 91.11% probability of S + RT being cost-effective over RT alone at a willingness-to-pay of US$1 683 000 per QALY. In practice, the results of our study indicate that, by adopting the S + RT strategy, there would still be a chance of 18.11% of not paying extra at a willingness-to-pay of US$50 000 per QALY. Those results are sensitive to the costs of hospice palliative care. Our results suggest that adopting a standard S + RT approach for patients with MSCC is likely to increase health care costs but would result in improved outcomes.
Notes
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PubMed ID
22505658 View in PubMed
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Epidemiology and clinical outcomes of acute spine trauma and spinal cord injury: experience from a specialized spine trauma center in Canada in comparison with a large national registry.

https://arctichealth.org/en/permalink/ahliterature147469
Source
J Trauma. 2009 Nov;67(5):936-43
Publication Type
Article
Date
Nov-2009
Author
Deepa Kattail
Julio C Furlan
Michael G Fehlings
Author Affiliation
Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario M5T 2S8, Canada.
Source
J Trauma. 2009 Nov;67(5):936-43
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Accidental Falls - statistics & numerical data
Accidents, Traffic - statistics & numerical data
Adolescent
Adult
Aged
Aged, 80 and over
Athletic Injuries - epidemiology
Canada - epidemiology
Female
Hospital Mortality
Humans
Length of Stay
Male
Middle Aged
Ontario - epidemiology
Registries
Spinal Cord Injuries - epidemiology
Spinal Injuries - epidemiology - etiology
Trauma Centers
Treatment Outcome
Young Adult
Abstract
Because relevant changes in the epidemiology of the traumatic spinal cord injury (SCI) has been reported, we sought to examine the demographics, injury characteristics, and clinical outcomes of patients with spine trauma who have been treated in our spine trauma center.
All consecutive patients with acute spine trauma who were admitted in our center from 1996 to 2007 were included. Comparisons among the four triennia were performed for demographics, injury characteristics, and clinical outcomes. Also, our 2001/2002 SCI data were compared with the National Trauma Registry (NTR) dataset.
There were 569 patients (394 males, 175 females; ages from 15 to 102 years, mean age of 50 years) who were admitted with acute spine trauma. Although demographic profile has been steady over the last four triennia, the frequency of more severe spine trauma at the lumbosacral levels due to falls has increased overtime. The mean length of stay and in-hospital mortality rates have not significantly changed during the past 12 years. Our in-hospital mortality rate (4%) was significantly lower than the provincial rate from the Ontario Trauma Registry (7.5%; p = 0.005). Comparisons between our SCI data and the NTR dataset showed significant differences regarding age groups.
Our results indicate that significant differences in the characteristics of acute spine trauma but not demographics have occurred overtime in our institution. Also, there were significant differences between our database and the NTR regarding age distribution. Our reduced in-hospital mortality rates in comparison with the provincial data reinforce the recommendations for early management of SCI patients in a spine trauma center.
PubMed ID
19901651 View in PubMed
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Incidence and prevalence of spinal cord injury in Canada: a national perspective.

https://arctichealth.org/en/permalink/ahliterature124696
Source
Neuroepidemiology. 2012;38(4):219-26
Publication Type
Article
Date
2012
Author
Vanessa K Noonan
Matthew Fingas
Angela Farry
David Baxter
Anoushka Singh
Michael G Fehlings
Marcel F Dvorak
Author Affiliation
Rick Hansen Institute, Vancouver, BC, Canada. Vanessa.Noonan@vch.ca
Source
Neuroepidemiology. 2012;38(4):219-26
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada - epidemiology
Child
Child, Preschool
Cohort Studies
Female
Humans
Incidence
Infant
Male
Middle Aged
Prevalence
Quadriplegia - epidemiology - etiology
Spinal Cord Diseases - epidemiology - etiology
Spinal Cord Injuries - epidemiology - etiology
Young Adult
Abstract
Despite decades of research, there are no national estimates of the incidence or prevalence of spinal cord injury (SCI) in Canada. Our objective was to utilize the best available data to estimate the incidence and prevalence of traumatic SCI (TSCI) and non-traumatic SCI (NTSCI) in Canada for 2010.
Initial incidence (number of TSCIs at injury scene) and discharge incidence (number discharged into the community) were calculated using published TSCI rates from Alberta and NTSCI rates from Australia. Prevalence was estimated by applying TSCI and NTSCI discharge incidence rates to historical Canadian population demographics using a cohort survival model and age-specific mortality rates for tetraplegia and paraplegia.
The estimated 2010 initial incidence of TSCI is 1,785 cases per year, and the discharge incidence is 1,389 (41 per million). The estimated discharge incidence for NTSCI is 2,286 cases (68 per million). The prevalence of SCI in Canada is estimated to be 85,556 persons (51% TSCI and 49% NTSCI).
This study provides the first estimates of the incidence and prevalence of SCI in Canada. More population-based studies are needed, particularly for NTSCI, as an increasing number of Canadians are expected to be affected by SCI.
PubMed ID
22555590 View in PubMed
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Meeting the privacy requirements for the development of a multi-centre patient registry in Canada: the Rick Hansen Spinal Cord Injury Registry.

https://arctichealth.org/en/permalink/ahliterature107862
Source
Healthc Policy. 2013 May;8(4):87-99
Publication Type
Article
Date
May-2013
Author
Vanessa K Noonan
Nancy P Thorogood
Phalgun B Joshi
Michael G Fehlings
B Catharine Craven
Gary Linassi
Daryl R Fourney
Brian K Kwon
Christopher S Bailey
Eve C Tsai
Brian M Drew
Henry Ahn
Deborah Tsui
Marcel F Dvorak
Author Affiliation
Director of Research, Rick Hansen Institute, Vancouver, BC.
Source
Healthc Policy. 2013 May;8(4):87-99
Date
May-2013
Language
English
Publication Type
Article
Keywords
Bias (epidemiology)
Canada - epidemiology
Computer Security
Confidentiality
Health Policy
Humans
Informed consent
Registries - standards
Spinal Cord Injuries - epidemiology
Abstract
Privacy legislation addresses concerns regarding the privacy of personal information; however, its interpretation by research ethics boards has resulted in significant challenges to the collection, management, use and disclosure of personal health information for multi-centre research studies. This paper describes the strategy used to develop the national Rick Hansen Spinal Cord Injury Registry (RHSCIR) in accordance with privacy statutes and benchmarked against best practices. An analysis of the regional and national privacy legislation was conducted to determine the requirements for each of the 31 local RHSCIR sites and the national RHSCIR office. A national privacy and security framework was created for RHSCIR that includes a governance structure, standard operating procedures, training processes, physical and technical security and privacy impact assessments. The framework meets a high-water mark in ensuring privacy and security of personal health information nationally and may assist in the development of other national or international research initiatives.
Notes
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PubMed ID
23968640 View in PubMed
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Modeling the patient journey from injury to community reintegration for persons with acute traumatic spinal cord injury in a Canadian centre.

https://arctichealth.org/en/permalink/ahliterature107347
Source
PLoS One. 2013;8(8):e72552
Publication Type
Article
Date
2013
Author
Argelio Santos
James Gurling
Marcel F Dvorak
Vanessa K Noonan
Michael G Fehlings
Anthony S Burns
Rachel Lewis
Lesley Soril
Nader Fallah
John T Street
Lise Bélanger
Andrea Townson
Liping Liang
Derek Atkins
Author Affiliation
Rick Hansen Institute, Vancouver, Canada ; Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
Source
PLoS One. 2013;8(8):e72552
Date
2013
Language
English
Publication Type
Article
Keywords
Acute Disease
Canada
Computer simulation
Humans
Logistic Models
Outcome Assessment (Health Care)
Residence Characteristics
Spinal Cord Injuries - rehabilitation
Time Factors
Treatment Outcome
Abstract
A patient's journey through the health care system is influenced by clinical and system processes across the continuum of care.
To inform optimized access to care and patient flow for individuals with traumatic spinal cord injury (tSCI), we developed a simulation model that can examine the full impact of therapeutic or systems interventions across the care continuum for patients with traumatic spinal cord injuries. The objective of this paper is to describe the detailed development of this simulation model for a major trauma and a rehabilitation centre in British Columbia (BC), Canada, as part of the Access to Care and Timing (ACT) project and is referred to as the BC ACT Model V1.0.
To demonstrate the utility of the simulation model in clinical and administrative decision-making we present three typical scenarios that illustrate how an investigator can track the indirect impact(s) of medical and administrative interventions, both upstream and downstream along the continuum of care. For example, the model was used to estimate the theoretical impact of a practice that reduced the incidence of pressure ulcers by 70%. This led to a decrease in acute and rehabilitation length of stay of 4 and 2 days, respectively and a decrease in bed utilization of 9% and 3% in acute and rehabilitation.
The scenario analysis using the BC ACT Model V1.0 demonstrates the flexibility and value of the simulation model as a decision-making tool by providing estimates of the effects of different interventions and allowing them to be objectively compared. Future work will involve developing a generalizable national Canadian ACT Model to examine differences in care delivery and identify the ideal attributes of SCI care delivery.
Notes
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PubMed ID
24023623 View in PubMed
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The National Trauma Registry as a Canadian spine trauma database: a validation study using an institutional clinical database.

https://arctichealth.org/en/permalink/ahliterature131242
Source
Neuroepidemiology. 2011;37(2):96-101
Publication Type
Article
Date
2011
Author
Julio C Furlan
Michael G Fehlings
Author Affiliation
Division of Genetics and Development, Toronto Western Research Institute, Toronto, Ont., Canada. jcfurlan@gmail.com
Source
Neuroepidemiology. 2011;37(2):96-101
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada - epidemiology
Databases, Factual - standards
Female
Hospitalization
Humans
Male
Middle Aged
Registries - standards
Retrospective Studies
Spinal Cord Injuries - diagnosis - epidemiology
Young Adult
Abstract
Miscoding is a common source of error in population-based registries. Given this, we performed a validation study comparing the Canadian National Trauma Registry (NTR) data based on the 10th Revision of the International Classification of Diseases coding with clinical data from an institutional database.
All patients with acute spine trauma who were admitted to Toronto Western Hospital from May 2003 to April 2007 were included. Accuracy, sensitivity and specificity were estimated having chart data abstraction as the gold standard.
There were 92 patients with spine trauma (50 males, 42 females; ages from 16 to 102 years). The use of the NTR as a spine trauma database has an accuracy of 87%, sensitivity of 89.8% and specificity of 25%. If the same database is considered as a spinal cord injury (complete motor injury) database, there will be a decrease in the precision with an accuracy of 32.6%, sensitivity of 81.3% and specificity of 6.7%.
Our results indicate that the NTR may be relatively more precise when used as a database of spine trauma in comparison with its use as a spinal cord injury database. However, the low specificity suggests that the NTR should be comprehensively validated using data from the other institutions that contribute with data collection for the NTR.
PubMed ID
21921642 View in PubMed
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8 records – page 1 of 1.