Getting on the Right Track: Standardizing Care For Persons With Neurotrauma In Ontario

Abstract

<h3>Research Objectives</h3> To develop an evidence-based neurotrauma pathway and evaluation strategy for individuals with traumatic brain injury (TBI) and traumatic spinal cord injury (tSCI) living in Ontario, Canada. <h3>Design</h3> Survey. <h3>Setting</h3> Rehabilitation hospital. <h3>Participants</h3> Stakeholders from across Ontario (n = 125; people with lived experience, clinicians, researchers, funders, health system planners, and community service providers from different sectors) developed an Ideal Pathway of care for individuals with TBI and tSCI. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Working Groups (Acute, Rehabilitation, Community, and Critical Considerations) evaluated policy reports, published peer-reviewed literature, and clinical practice guidelines as well as interviewed persons with lived experience to develop the building blocks for the Ideal Neurotrauma Care Pathway. In addition, Working Groups reviewed potential data indicators from published sources and administrative datasets to create a core set of indicators that could be used to evaluate current care in the context of the Ideal Care Pathway. <h3>Results</h3> Nine subcommittee meetings, three one-day virtual summits, and 43 Working Group meetings were held from November 2021 to March 2022. Working Groups focused on appropriate assessment, initial management, and transition planning; access to specialized rehab, education of patients and families, and planning of community needs; and follow-up, mechanisms for care re-access, and holistic support for patients and families. The Critical Considerations Working Group identified elements poorly covered by current clinical guidelines and only partially supported in current healthcare systems (social determinants of health, marginalized populations, mental health issues, and peer and caregiver support). Forty-two data indicators were developed and reduced through a stakeholder prioritization exercise to a core set of 22 data indicators (8 in Acute, 4 in Rehab, 7 in Community, and 3 in Critical Considerations). <h3>Conclusions</h3> Through collaboration and consensus, a diverse group of stakeholders developed an evidence-based Ideal Pathway for neurotrauma care that could be generalized to other healthcare systems. The Ideal Pathway and companion quality data indicators will help reduce healthcare inequities and provides the care needed to optimize recovery after neurotrauma. <h3>Author(s) Disclosures</h3> There are no conflicts of interest to declare.