Understanding the Economic Impact of Clinical Variation in Care for Patients with Traumatic Spinal Cord Injury

Abstract

Traumatic spinal cord injury (TSCI) confers a substantial lifelong disability burden and economic costs for patients, health systems, and society. Australia has a low TSCI incidence rate, but its economic burden is significant. Despite medical advances, TSCI has no cure, thus effective prevention strategies and timely interventions are critical to enhance long-term patient outcomes. Evidence-informed clinical practice guidelines strongly advocate for rapid admission/transfer to a specialist spinal cord injury unit, timely surgery and comprehensive rehabilitation to optimise functional outcomes. However, adherence is reduced, and there is significant variation in referral patterns, access to specialist TSCI care, and timing of surgical intervention across the health system. This thesis bridges knowledge gaps in relation to the health economics of acute TSCI care delivery and impact of clinical variation to inform policy reforms promoting standardised, evidence-based practice for better outcomes.

Prior research has shown low admission rates for patients with TSCI to specialist SCI units. However, the geographic distribution of patients relative to specialist units and its impact on access to timely, appropriate care have not been examined. This thesis addresses these challenges and gaps in knowledge through the identification of acute care resource use drivers, quantifying the funding shortfall for specialist hospitals, mapping of patient pathways, and modelling an optimal care pathway incorporating the consensus guidelines in a way that the findings are relevant for both Australian and similar healthcare systems.

The findings elucidate the specific clinical and system determinants governing TSCI care management and its economic implications. The findings contribute to the ongoing dialogue on value-based care, resource allocation, and policy interventions, with implications extending beyond the Australian healthcare system to countries with comparable settings.