• Argelio Santos, James Gurling, Marcel F Dvorak, Vanessa K Noonan, Michael G Fehlings, Anthony S Burns, Rachel Lewis, Lesley Soril, Nader Fallah, John T Street, Lise Bélanger, Andrea Townson, Liping Liang, and Derek Atkins.
• Rick Hansen Institute, Vancouver, Canada ; Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
• Plos One. 2013 Jan 1;8(8):e72552.

BackgroundA patient's journey through the health care system is influenced by clinical and system processes across the continuum of care.MethodsTo inform optimized access to care and patient flow for individuals with traumatic spinal cord injury (tSCI), we developed a simulation model that can examine the full impact of therapeutic or systems interventions across the care continuum for patients with traumatic spinal cord injuries. The objective of this paper is to describe the detailed development of this simulation model for a major trauma and a rehabilitation centre in British Columbia (BC), Canada, as part of the Access to Care and Timing (ACT) project and is referred to as the BC ACT Model V1.0.FindingsTo demonstrate the utility of the simulation model in clinical and administrative decision-making we present three typical scenarios that illustrate how an investigator can track the indirect impact(s) of medical and administrative interventions, both upstream and downstream along the continuum of care. For example, the model was used to estimate the theoretical impact of a practice that reduced the incidence of pressure ulcers by 70%. This led to a decrease in acute and rehabilitation length of stay of 4 and 2 days, respectively and a decrease in bed utilization of 9% and 3% in acute and rehabilitation.ConclusionThe scenario analysis using the BC ACT Model V1.0 demonstrates the flexibility and value of the simulation model as a decision-making tool by providing estimates of the effects of different interventions and allowing them to be objectively compared. Future work will involve developing a generalizable national Canadian ACT Model to examine differences in care delivery and identify the ideal attributes of SCI care delivery.

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