Fast-Track Aassessment Clinic: Selection of Patients for a One-Stop Hip Assessment Clinic

Sa, Johnson; Kalairajah, Yegappan; Moonot, Pradeep; Steele, Nicole M.; Field, RE

doi:10.1308/003588408x242024

Cited by 10 publications

(16 citation statements)

References 7 publications

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“…29 Attempts are currently being made by the NHS to use Oxford PROMs to prioritise patients for hip and knee replacement, restricting surgery to those with lower (worse) scores. Real orthopaedic expertise is required to assess this latter group of patients, whom it is not so easy to pigeonhole, 30 and in whom there is no evidence to suggest that they do not gain equally good benefit from surgery. More evidence is required before pre-operative scores can be used to reliably predict an individual's requirement for joint replacement and to prioritise their operation appropriately.…”

Section: Andmentioning

confidence: 99%

Assessing patients for joint replacement

Judge

Arden

Price

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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We obtained pre-operative and six-month post-operative Oxford hip (OHS) and knee scores (OKS) for 1523 patients who underwent total hip replacement and 1784 patients who underwent total knee replacement. They all also completed a six-month satisfaction question. Scatter plots showed no relationship between pre-operative Oxford scores and six-month satisfaction scores. Spearman's rank correlation coefficients were -0.04 (95% confidence interval (CI) -0.09 to 0.01) between OHS and satisfaction and 0.04 (95% CI -0.01 to 0.08) between OKS and satisfaction. A receiver operating characteristic (ROC) curve analysis was used to identify a cut-off point for the pre-operative OHS/OKS that identifies whether or not a patient is satisfied with surgery. We obtained an area under the ROC curve of 0.51 (95% CI 0.45 to 0.56) for hip replacement and 0.56 (95% CI 0.51 to 0.60) for knee replacement, indicating that pre-operative Oxford scores have no predictive accuracy in distinguishing satisfied from dissatisfied patients. In the NHS widespread attempts are being made to use patient-reported outcome measures (PROMs) data for the purpose of prioritising patients for surgery. Oxford hip and knee scores have no predictive accuracy in relation to post-operative patient satisfaction. This evidence does not support their current use in prioritising access to care.

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Section: Andmentioning

confidence: 99%

Assessing patients for joint replacement

Judge

Arden

Price

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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“…All the included studies were from high income, developed countries: eight from the UK,16 26–32 five from Canada,33–37 two from New Zealand15 38 and one each from Australia39 and the Netherlands 40. There were some differences in the patient population being evaluated across the studies: seven studies included patients with a knee condition only,26 27 30–33 37 two studies with a hip condition only16 29 and eight studies had patients with hip or knee pain 15 28 34–36 38–40. Specific characteristics of each study are described in table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen of the studies were based on healthcare activity in hospitals within secondary care,27–39 with consultation led by a physiotherapist in three studies,15 30 34 physiotherapist and orthopaedic surgeon/expert physician in seven,27 28 31 33 35 37 39 orthopaedic surgeon-led in two29 38 and GP led care in the remaining studies 16 26 32 40. Only three studies had a clinic that was located in primary care 32 35 38.…”

Section: Resultsmentioning

confidence: 99%

Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic review

et al. 2019

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ObjectiveMusculoskeletal care pathways are variable and inconsistent. The aim of this systematic review was to evaluate the evidence for the clinical and/or cost effectiveness of current care pathways for adults with hip and/or knee pain referred for specialist opinion.DesignSystematic review.Data sourcesElectronic database searches were carried out in MEDLINE, MEDLINE In-Process, Cumulative Index of Nursing and Allied Health Literature, Embase, PEDro, PubMed, Web of Science, Cochrane Central and Health Management Information Consortium without language restriction from 1990 onwards. Websites were reviewed for grey literature.Eligibility criteriaAll study designs and documents that considered care pathways for adults with musculoskeletal hip and/or knee pain referred for specialist opinion were screened by two reviewers. Risk of bias was assessed using The Critical Appraisal Skills Programme checklist for randomised controlled trials and the Joanna Briggs Institute checklists.Data extraction and synthesisData extraction and quality assessment were performed by one reviewer and checked by a second. Findings are reported narratively.ResultsThe titles and abstracts of 1248 articles were screened and 140 full-text articles retrieved. 19 papers reporting 17 studies met the study inclusion criteria. Quality was low due to study design and methodological flaws. Most of the outcomes relate to organisational process at the ‘meso’ level of a whole systems approach.ConclusionIt can be concluded that the pathway is not linear, containing variations and activity loops. The available evidence suggests that, from the point of referral for specialist opinion, a model is required that integrates the skills of all the different healthcare professionals and streamlining is required to ensure that individuals are seen by the healthcare professional that best meets their needs. There is very limited evidence of patient experience informing knee and hip care pathways.PROSPERO registration numberCRD42016035510.

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“…Previous studies have evaluated triage prioritisation tools for hip and knee pain, but these were not based on predictor variables [10] and there had been a lack of transparency about what variable prioritisation is based on [11,25,26]. Further research is required to validate the findings of this study and to develop the prioritisation tools and training required for an optimal pathway that could be tested in a randomized control trial in the future.…”

Section: Predictors Of Patient Rated Pain and Function At Time Of Conmentioning

confidence: 96%

“…To try and improve efficiency and resource use in secondary care, referral prioritisation systems have been developed for hip and or knee pain and tested to fast-track cases for surgical opinion based on general practitioner referral information [10,11]. The limitation of these systems is that the prioritisation criteria has lacked sensitivity and specificity as individuals move between surgical and conservative pathways.…”

Section: Introductionmentioning

confidence: 99%

Using routine referral data for patients with knee and hip pain to improve access to specialist care

Button

Spasić

Playle

et al. 2020

BMC Musculoskelet Disord

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Background: Referral letters from primary care contain a large amount of information that could be used to improve the appropriateness of the referral pathway for individuals seeking specialist opinion for knee or hip pain. The primary aim of this study was to evaluate the content of the referral letters to identify information that can independently predict an optimal care pathway. Methods: Using a prospective longitudinal design, a convenience sample of patients with hip or knee pain were recruited from orthopaedic, specialist general practice and advanced physiotherapy practitioner clinics. Individuals completed a Knee or hip Osteoarthritis Outcome Score at initial consultation and after 6 months. Participant demographics, body mass index, medication and co-morbidity data were extracted from the referral letters. Free text of the referral letters was mapped automatically onto the Unified Medical Language System to identify relevant clinical variables. Treatment outcomes were extracted from the consultation letters. Each outcome was classified as being an optimal or sub-optimal pathway, where an optimal pathway was defined as the one that results in the right treatment at the right time. Logistic regression was used to identify variables that were independently associated with an optimal pathway. Results: A total of 643 participants were recruited, 419 (66.7%) were classified as having an optimal pathway. Variables independently associated with having an optimal care pathway were lower body mass index (OR 1.0, 95% CI 0.9 to 1.0 p = 0.004), named disease or syndromes (OR 1.8, 95% CI 1.1 to 2.8, p = 0.02) and taking pharmacologic substances (OR 1.8, 95% CI 1.0 to 3.3, p = 0.02). Having a single diagnostic procedure was associated with a suboptimal pathway (OR 0.5, 95% CI 0.3 to 0.9 p < 0.001). Neither Knee nor Hip Osteoarthritis Outcome scores were associated with an optimal pathway. Body mass index was found to be a good predictor of patient rated function (coefficient − 0.8, 95% CI-1.1, − 0.4 p < 0.001). Conclusion: Over 30% of patients followed sub-optimal care pathway, which represents potential inefficiency and wasted healthcare resource. A core data set including body mass index should be considered as this was a predictor of optimal care and patient rated pain and function.

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Fast-Track Aassessment Clinic: Selection of Patients for a One-Stop Hip Assessment Clinic

Cited by 10 publications

References 7 publications

Assessing patients for joint replacement

Assessing patients for joint replacement

Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic review

Using routine referral data for patients with knee and hip pain to improve access to specialist care

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