1 Department of Surgery, University of Toronto , Toronto, Ontario, Canada .
2 Rick Hansen Institute , Vancouver, British Columbia, Canada .
J Neurotrauma. 2017 Oct 15;34(20):2934-2940. doi: 10.1089/neu.2016.4938. Epub 2017 Aug 2.
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.
在当今的经济环境下，需要证明医疗支出的投资回报，并且需要依据证据来为临床实践和政策提供信息。对于决策者、临床医生和研究人员来说，驾驭这一过程是困难的。本文将描述如何整合知识转化框架和循证决策过程，以澄清问题、构建选择并规划实施，从而对创伤性脊髓损伤（tSCI）领域的临床实践和政策产生影响。“获取护理和时机（ACT）”项目专注于优化加拿大创伤性脊髓损伤患者获得专业医疗护理的途径和时机。开发了一个模拟模型，该模型使用当前患者数据来解决医疗系统面临的复杂问题。在一次研讨会上，参与者强调了将干预措施与短期和长期结果联系起来以推动变革的重要性。目前，没有用于监测 tSCI 后绩效的国家、系统层面的指标。尽管创伤性脊髓损伤后的理想护理系统尚不清楚，但指标收集将建立一个衡量改进的基线。研讨会参与者优先考虑了两个从临床医生和患者角度来看重要的指标——及时进入康复和有意义的社区参与。tSCI 护理的 ACT 模拟模型将用于促进确定指标的采用，并提供干预措施与潜在结果之间的预测联系。面向结果的指标的标准化收集将有助于评估护理的途径和时机，并定义 SCI 后的理想护理系统。
