title: Understanding Length of Stay after Spinal Cord Injury: Insights and Limitations from the Access to Care and Timing Project.
abstract: Costs associated with initial hospitalization following spinal cord injury (SCI) are substantial, and a major driver of costs is the length of stay (LOS); that is, the time that the injured individual remains hospitalized prior to community reintegration. Our aim was to study the factors and variables that contribute to LOS following traumatic SCI. Modeling (process mapping of the SCI healthcare delivery system in Canada and discrete event simulation) and regression analysis using a national registry of individuals with acute traumatic SCI in Canada, existing databases, and peer-reviewed literature were used to examine the driver of LOS following traumatic SCI. In different jurisdictions, there is considerable variation in the definitions and methods used to determine LOS following SCI. System LOS can be subdivided into subcomponents, and progression through these is not unidirectional. Modeling reveals that healthcare organization and processes are important contributors to differences in LOS independent of patient demographics and injury characteristics. Future research is required to identify and improve understanding of contributors to LOS following traumatic SCI. This will help enhance system performance. Work in this area will be facilitated by the adoption of common terminology and definitions, as well as by the use of simulations and modeling.
authors.affiliation: 1 Division of Physiatry, Department of Medicine, University of Toronto , Toronto Ontario, Canada .
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Burns
authors.affiliation: 2 Rick Hansen Institute , Vancouver, British Columbia, Canada .
authors.forename: Argelio
authors.initials: A
authors.lastname: Santos
authors.affiliation: 2 Rick Hansen Institute , Vancouver, British Columbia, Canada .
authors.forename: Christiana L
authors.initials: CL
authors.lastname: Cheng
authors.affiliation: 2 Rick Hansen Institute , Vancouver, British Columbia, Canada .
authors.forename: Elaine
authors.initials: E
authors.lastname: Chan
authors.affiliation: 2 Rick Hansen Institute , Vancouver, British Columbia, Canada .
authors.forename: Nader
authors.initials: N
authors.lastname: Fallah
authors.affiliation: 3 Operations and Logistics Division, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Derek
authors.initials: D
authors.lastname: Atkins
authors.affiliation: 4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
authors.affiliation: 5 Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada .
authors.forename: Chester
authors.initials: C
authors.lastname: Ho
authors.affiliation: 6 University of Toronto Spine Program , Toronto, Ontario, Canada .
authors.forename: Henry
authors.initials: H
authors.lastname: Ahn
authors.affiliation: 7 Université Laval , Québec, Canada .
authors.forename: Jerome
authors.initials: J
authors.lastname: Paquet
authors.affiliation: 4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Brian K
authors.initials: BK
authors.lastname: Kwon
authors.affiliation: 2 Rick Hansen Institute , Vancouver, British Columbia, Canada .
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Noonan
mesh_terms: D002170:Canada; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D013119:Spinal Cord Injuries / Q000191:economics / Q000628:therapy
keywords: LOS; SCI; delivery of healthcare; health services research