التفاصيل البيبلوغرافية
| العنوان: |
A geospatial examination of specialist care accessibility and impact on health outcomes for patients with acute traumatic spinal cord injury in New South Wales, Australia: a population record linkage study |
| المؤلفون: |
Sharwood, Lisa N., Whyatt, David, Vaikuntam, Bharat P., Cheng, Christiana L., Noonan, Vanessa K., Joseph, Anthony P., Ball, Jonathon, Stanford, Ralph E., Kok, Mei-Ruu, Withers, Samuel R., Middleton, James W. |
| المساهمون: |
icare, National Health and Medical Research Council |
| المصدر: |
BMC Health Services Research ; volume 21, issue 1 ; ISSN 1472-6963 |
| بيانات النشر: |
Springer Science and Business Media LLC |
| سنة النشر: |
2021 |
| مصطلحات موضوعية: |
Health Policy |
| الوصف: |
Background Timely treatment is essential for achieving optimal outcomes after traumatic spinal cord injury (TSCI), and expeditious transfer to a specialist spinal cord injury unit (SCIU) is recommended within 24 h from injury. Previous research in New South Wales (NSW) found only 57% of TSCI patients were admitted to SCIU for acute post-injury care; 73% transferred within 24 h from injury. We evaluated pre-hospital and inter-hospital transfer practices to better understand the post-injury care pathways impact on patient outcomes and highlight areas in the health service pathway that may benefit from improvement. Methods This record linkage study included administrative pre-hospital (Ambulance), admissions (Admitted Patients) and costs data obtained from the Centre for Health Record Linkage, NSW. All patients aged ≥16 years with incident TSCI in NSW (2013–2016) were included. We investigated impacts of geographical disparities on pre-hospital and inter-hospital transport decisions from injury location using geospatial methods. Outcomes assessed included time to SCIU, surgery and the impact of these variables on the experience of inpatient complications. Results Inclusion criteria identified 316 patients, geospatial analysis showed that over half (53%, n = 168) of all patients were injured within 60 min road travel of a SCIU, yet only 28.6% ( n = 48) were directly transferred to a SCIU. Patients were more likely to experience direct transfer to a SCIU without comorbid trauma ( p < 0.01) but higher ICISS ( p < 0.001), cervical injury ( p < 0.01), and transferred by air-ambulance ( p < 0.01). Indirect transfer to SCIU was more likely with two or more additional traumatic injuries ( p < 0.01) or incomplete injury ( p < 0.01). Patients not admitted to SCIU at all were older ( p = 0.05) with lower levels of injury ( p < 0.01). Direct transfers received earlier operative intervention (median (IQR) 12.9(7.9) hours), compared with patients transferred indirectly to SCIU (median (IQR) ... |
| نوع الوثيقة: |
article in journal/newspaper |
| اللغة: |
English |
| DOI: |
10.1186/s12913-021-06235-4 |
| DOI: |
10.1186/s12913-021-06235-4.pdf |
| DOI: |
10.1186/s12913-021-06235-4/fulltext.html |
| الإتاحة: |
https://doi.org/10.1186/s12913-021-06235-4Test |
| حقوق: |
http://creativecommons.org/licenses/by/4.0Test/ ; http://creativecommons.org/licenses/by/4.0Test/ |
| رقم الانضمام: |
edsbas.CBD01D20 |
| قاعدة البيانات: |
BASE |
