An international survey of the structure and process of care for traumatic spinal cord injury in acute and rehabilitation facilities: lessons learned from a pilot study

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  • Aidin Abedi
  • Harvinder S. Chhabra
  • Julia Maria D’Andréa Greve
  • Nasser M. Khan
  • Eerika Koskinen
  • Kenny Yat Hong Kwan
  • Nan Liu
  • James W. Middleton
  • Sasa Moslavac
  • Vafa Rahimi-Movaghar
  • Colleen O’Connell
  • Jean G. Previnaire
  • Alpesh Patel
  • Giorgio Scivoletto
  • Lisa N. Sharwood
  • Andrea Townson
  • Susan Urquhart
  • Aki Vainionpää
  • Atiq Uz Zaman
  • Vanessa K. Noonan
  • Christiana L. Cheng

Background: To describe the key findings and lessons learned from an international pilot study that surveyed spinal cord injury programs in acute and rehabilitation facilities to understand the status of spinal cord injury care. Methods: An online survey with two questionnaires, a 74-item for acute care and a 51-item for rehabilitation, was used. A subset of survey items relevant to the themes of specialized care, timeliness, patient-centeredness, and evidence-based care were operationalized as structure or process indicators. Percentages of facilities reporting the structure or process to be present, and percentages of indicators met by each facility were calculated and reported separately for facilities from high-income countries (HIC) and from low and middle-income countries (LMIC) to identify “hard to meet” indicators defined as those met by less than two-thirds of facilities and to describe performance level. Results: A total of 26 acute and 26 rehabilitation facilities from 25 countries participated in the study. The comparison of the facilities based on the country income level revealed three general observations: 1) some indicators were met equally well by both HIC and LMIC, such as 24-hour access to CT scanners in acute care and out-patient services at rehabilitation facilities; 2) some indicators were hard to meet for LMIC but not for HIC, such as having a multidisciplinary team for both acute and rehabilitation settings; and 3) some indicators were hard to meet by both HIC and LMIC, including having peer counselling programs. Variability was also observed for the same indicator between acute and rehabilitation facilities, and a wide range in the total number of indicators met among HIC facilities (acute 59–100%; rehabilitation 36–100%) and among LMIC facilities (acute: 41–82%; rehabilitation: 36–93%) was reported. Conclusions: Results from this international pilot study found that the participating acute and rehabilitation facilities on average adhered to 74% of the selected indicators, suggesting that the structure and processes to provide ideal traumatic spinal cord injury care were broadly available. Recruiting a representative sample of SCI facilities and incorporating regional attributes in future surveys will be helpful to examine factors affecting adherence to indicators.

OriginalsprogEngelsk
Artikelnummer1565
TidsskriftBMC Health Services Research
Vol/bind22
ISSN1472-6963
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
The study is funded by the Praxis Spinal Cord Institute and the Government of Canada through Health Canada and Western Economic Diversification of Canada. CLC and VKN are employees of Praxis and were involved in the design of the study, the analysis and interpretation of data, and in writing the manuscript in collaboration with the coauthors.

Funding Information:
We would like to acknowledge Rowan Schouten, Lise Bélanger, and Tova Plashkes for their advice on the survey questionnaire, Glenys Maclsaac and Jessica Eapen for their support in developing the online survey, all the participating facilities for their contribution to the survey and all the individuals who collected the data for their facility, Zeina Waheed for research support, and Dilnur Kurban and Mel Chen for statistical support.

Publisher Copyright:
© 2022, The Author(s).

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