Developing quality of care indicators for patients with traumatic and non-traumatic spinal cord injury (SCI): A feasibility study using administrative health data

The Journal of Spinal Cord Medicine, 2015 · DOI: 10.1179/2045772315Y.0000000043 · Published: January 1, 2015

Spinal Cord Injury Healthcare Research Methodology & Design

Simple Explanation

This study aimed to develop quality indicators for spinal cord injury (SCI) care using administrative data. The researchers wanted to understand differences in care based on facility type and SCI pathology. They analyzed data from Ontario, Canada, identifying traumatic (TSCI) and non-traumatic (NTSCI) SCI cases to explore variations in treatment and outcomes. The research revealed challenges in data completeness and coding practices, particularly for non-traumatic SCI. They found variations in treatment based on whether patients were admitted to trauma/spine centers versus non-trauma centers, and differences between traumatic and non-traumatic SCI regarding rehabilitation admissions. The study suggests a need for improved data collection and standardized coding to develop meaningful quality indicators. These indicators could then be used to drive system performance measurement, clinical practice benchmarking, and overall better care for individuals with SCI.

Study Duration

6 Years

Participants

7,693 SCI cases in Ontario, Canada

Evidence Level

Retrospective cohort study

Key Findings

1
The study identified 7,693 SCI cases, with 20% categorized as traumatic SCI (TSCI) and 80% as non-traumatic SCI (NTSCI).
2
More individuals admitted to a trauma/spine center were seen by an orthopedic surgeon or a neurosurgeon compared to those admitted to non-trauma centers for both TSCI and NTSCI.
3
Only 25.7% of the NTSCI cohort were admitted to a rehabilitation facility from a trauma/spine center, compared to 58.9% of those with TSCI.

Research Summary

This study explored the feasibility of developing health system quality indicators for traumatic and non-traumatic spinal cord injury (SCI) using administrative data in Ontario, Canada. The objectives were to inform the development of these indicators and to examine differences in care based on facility type and SCI pathology. The research identified a cohort of 7,693 SCI cases and found challenges in data completeness and coding, particularly for non-traumatic SCI (NTSCI). Variations in treatment patterns were observed between trauma/spine centers and non-trauma centers, as well as between traumatic and non-traumatic SCI cases. The study concluded that improved data collection processes and standardized coding are needed to develop robust quality indicators for SCI care. These indicators can drive system performance measurement and improve overall care for individuals with SCI.

Practical Implications

Improved Data Collection

Implementing province-wide processes to flag incomplete data and provide incentives for comprehensive data collection is crucial for developing quality indicators.

Standardized Coding

Achieving consensus on the coding for NTSCI is essential for developing meaningful health system indicators and accurately identifying cases.

Benchmarking and Performance Measurement

The developed quality indicators can be used to benchmark clinical practices, measure system performance, and ultimately improve the quality of care for individuals with SCI.

Study Limitations

1
Need to validate ICD-10 codes used to define SCI, particularly NTSCI, to ensure accurate case identification.
2
Limitations with respect to completeness and accuracy of diagnostic coding across health care facilities.
3
Has not yet examined the feasibility of developing other indicators for inpatient rehabilitation, complex-continuing care, long-term care, home care or primary care.

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