Patient-centred care: Using operations research methods to improve care for spinal cord patients

With Derek Atkins, Marcel Dvorak, Vanessa Noonan, & John Street

When a person sustains a spinal cord injury, what are the factors in their care that influence the long-term outcomes? This is one of the questions addressed by a multi-site and long-term study being led by a team of operations research experts from the Centre for Operations Excellence at the Sauder School of Business and surgeons at Vancouver General Hospital, the quaternary care centre for spinal cord injuries in BC.

Dr. John Street substituted for Dr. Marcel Dvorak, and began the presentation by describing two patients with similar injuries but very different outcomes. Data gathered by the research team demonstrated that more than 75% of patients with spinal cord injuries suffer one or more adverse events or complications during their care. The overall goal of the study was to estimate the effect of interventions throughout the system of care (first responders, acute care, rehabilitation and community care) for spinal cord patients.

Dr. Derek Atkins described the parts of that journey of care, emphasizing that episodes of care need to be followed over the lifetime of the patient, with a focus on improving quality of life. He presented several scenarios in which specific interventions could be improved that would change many aspects of the patient’s journey of care, and as a consequence, the use of resources in the health care system. He showed simulation models that captured many different trajectories through the system of care and the data that are being collected on patients at multiple sites across Canada.

Dr. Vanessa Noonan used the models to illustrate how several interventions, both clinical and administrative, might affect the patient’s quality of life as well as use of resources in the health care system. She showed how this information can be used in a business case for planning for future care needs. In addition, she showed how the models could be used to compare two patient populations who are treated at different centres and evaluate the impact that the different care they receive has on their outcomes. One of the major benefits of this modeling and data gathering is the view of the whole system as well as comparisons of care across sites.

About the Speakers

Derek Atkins
Derek Atkins, Professor of Operations Research at the Sauder School of Business, UBC was educated at Oxford, Lancaster and Warwick universities in the UK. He came to Canada in 1976. Since then he has taught and researched in operations research at UBC, concentrating on supply chain improvements and latterly in health care. During this time he was also Dean pro tem of the School and Associate Vice –President Academic, UBC. For five years he was the Director of the Centre for Operations Excellence at Sauder and many of his graduates now work in health care in BC.

Marcel Dvorak
Dr. Marcel Dvorak is a Professor and Head of the Academic Division of Spine, Department of Orthopaedics, at the University of British Columbia. He is also Medical Director of the Combined Neurosurgical and Orthopaedic Spine Program (CNOSP) at the Vancouver General Hospital. A strong proponent of clinical and academic focus through sub-specialization, he confines his practice to adult spine surgery. His teaching efforts have been focused on the education of spine surgeons in advanced spinal surgical decision-making and techniques, and his research focus is care of patients with spinal injuries. He is the Scientific Director of the Rick Hansen Institute.

*Note: Dr. Marcel Dvorak was away for the presentation. Dr. John Street substituted for his portion.

Vanessa Noonan
Vanessa Noonan is a physical therapist and she is currently the Director of Research for the Rick Hansen Institute. Her research interests include developing outcome measures and evaluating how to effectively integrate research into clinical practice. Vanessa is currently a co-investigator on the Access to Care and Timing project, which is a collaborative project between the Rick Hansen Institute and the Centre for Operations Research (at the UBC Sauder School of Business). She has also been involved with developing the Rick Hansen SCI Registry and assisted in the development of a comprehensive community-follow-up questionnaire for the Registry. In addition, Vanessa has worked with colleagues internationally to develop data sets for SCI.

John Street
John Street is an Orthopaedic Spine Surgery and an Assistant professor at UBC. He is both a MD and a PhD. He is co-Medical Director of the Complex Spine Program at Vancouver General Hospital, Clinical Lead for the Integrated Ambulatory Spine Program and Coordinator of the undergraduate and post graduate education program.