KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.
Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada.
Top Spinal Cord Inj Rehabil. 2023 Fall;29(Suppl):103-111. doi: 10.46292/sci23-00059S. Epub 2023 Nov 17.
People with traumatic spinal cord injury (tSCI) experience lifelong physical and emotional health impacts, needing specialized care that is complex to navigate. The non-standardized care pathways used by different jurisdictions to address these needs lead to care inequities and poor health outcomes.
To develop an evidence-based integrated tSCI Care Pathway, from time of injury to life in the community.
Eighty key partners engaged in planning, providing, and receiving tSCI care (1) identified existing guidelines, pathways, and care models; (2) created the tSCI Care Pathway with key elements or building blocks ("the what"), not specific recommendations ("the how") for each care stage (Acute, Rehabilitation, and Community), with elements highlighting the role of primary care and equity considerations on the pathway; (3) identified regional gaps in the tSCI Pathway and prioritized them for implementation; and (4) developed quality indicators.
The tSCI Pathway was drafted in overarching and detailed formats. For Acute Care, building blocks focused on appropriate assessment, initial management, and transition planning; for Rehabilitation, building blocks focused on access to specialized rehabilitation and assessment and planning of community needs; for Community, building blocks focused on follow-up, mechanisms for re-access, and holistic support for persons and families; and for equity considerations, building blocks focused on those at-risk or requiring complex supports. Team-based primary care and navigation supports were seen as crucial to reduce inequities.
This is the first comprehensive care pathway for tSCI. The Pathway is grounded in person-centred care, integrated care and services, and up-to-date clinical practice guidelines. The tSCI Care Pathway is flexible to regional realities and individual needs to ensure equitable care for all.
外伤性脊髓损伤（tSCI）患者会经历终生的身体和心理健康影响，需要专门的护理，而这种护理的复杂性难以应对。不同司法管辖区用于满足这些需求的非标准化护理途径导致了护理不平等和健康状况不佳的结果。
制定一个基于证据的综合 tSCI 护理途径，从受伤到社区生活。
80 名关键合作伙伴参与了规划、提供和接受 tSCI 护理（1）确定了现有的指南、途径和护理模式；（2）为每个护理阶段（急性、康复和社区）创建了 tSCI 护理途径的关键要素或构建块（“是什么”），而不是特定的建议（“怎么做”），强调了初级保健和途径上的公平考虑因素的作用；（3）确定了 tSCI 途径中的区域差距，并为实施确定了优先事项；（4）制定了质量指标。
tSCI 途径以总体和详细的格式起草。对于急性护理，构建块侧重于适当的评估、初步管理和过渡计划；对于康复护理，构建块侧重于获得专门的康复和评估以及规划社区需求；对于社区护理，构建块侧重于后续、重新获得的机制以及个人和家庭的整体支持；对于公平考虑因素，构建块侧重于那些处于风险之中或需要复杂支持的人。以团队为基础的初级保健和导航支持被视为减少不平等的关键。
这是 tSCI 的第一个综合护理途径。该途径基于以人为本的护理、综合护理和服务以及最新的临床实践指南。tSCI 护理途径具有灵活性，可以适应区域现实和个人需求，确保所有人都能获得公平的护理。
