What Is the Pathway to the Best Model of Care for Traumatic Spinal Cord Injury? Evidence-Based Guidance.

IF 2.4 Q1 REHABILITATION
Topics in Spinal Cord Injury Rehabilitation Pub Date : 2023-01-01 Epub Date: 2023-11-17 DOI:10.46292/sci23-00059S
Matheus Joner Wiest, Judith Gargaro, Mark T Bayley
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引用次数: 0

Abstract

Introduction: 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.

Purpose: To develop an evidence-based integrated tSCI Care Pathway, from time of injury to life in the community.

Methods and analysis: 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.

Outcomes: 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.

Conclusion: 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.

创伤性脊髓损伤最佳护理模式的途径是什么?循证指导。
导言:外伤性脊髓损伤(tSCI)患者终生都会受到身体和情绪方面的健康影响,需要复杂的专业护理。不同辖区为满足这些需求而采用的非标准化护理路径导致了护理不公平和不良的健康结果。目的:开发基于证据的综合创伤性脊髓损伤(tSCI)护理路径,包括从受伤到在社区生活的整个过程:参与规划、提供和接受创伤后精神创伤护理的 80 个主要合作伙伴(1)确定了现有的指南、路径和护理模式;(2)创建了创伤后精神创伤护理路径,其中包括每个护理阶段(急性期、康复期和社区期)的关键要素或构件("做什么"),而不是具体建议("怎么做"),并强调了初级护理的作用和路径中的公平考虑因素;(3)确定了创伤后精神创伤护理路径中的地区差距,并将其列为优先实施事项;以及(4)制定了质量指标:以总体和详细的形式起草了 tSCI 途径。在急症护理方面,构建模块的重点是适当的评估、初始管理和过渡规划;在康复方面,构建模块的重点是获得专门的康复服务以及社区需求的评估和规划;在社区方面,构建模块的重点是后续行动、重新获得服务的机制以及对个人和家庭的全面支持;在公平考虑方面,构建模块的重点是高危人群或需要复杂支持的人群。以团队为基础的初级护理和导航支持被认为是减少不平等的关键:这是首个针对慢性阻塞性肺病的综合护理路径。该路径立足于以人为本的护理、综合护理和服务以及最新的临床实践指南。tSCI 护理路径可根据地区实际情况和个人需求灵活调整,以确保为所有人提供公平的护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.20
自引率
3.40%
发文量
33
期刊介绍: Now in our 22nd year as the leading interdisciplinary journal of SCI rehabilitation techniques and care. TSCIR is peer-reviewed, practical, and features one key topic per issue. Published topics include: mobility, sexuality, genitourinary, functional assessment, skin care, psychosocial, high tetraplegia, physical activity, pediatric, FES, sci/tbi, electronic medicine, orthotics, secondary conditions, research, aging, legal issues, women & sci, pain, environmental effects, life care planning
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