Implementation of a quality care management system for patients with arthritis of the hip and knee

Doerr, Christine; Graves, Stephen; Mercer, Graham; Osborne, Richard H.

doi:10.1071/ah11107

Cited by 12 publications

(18 citation statements)

References 7 publications

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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%

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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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Section: Resultsmentioning

confidence: 99%

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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“…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: 95%

“…The organisation of care around three different professional specialities (specialist GP, advanced physiotherapy practitioner and orthopaedics) represents further variation compared to that already described in the literature. For example, combined physiotherapist and orthopaedic clinics [28][29][30][31][32], separate orthopaedic and physiotherapist clinics [25,33] or musculoskeletal clinical assessment triage and treatment service (MCATS) combing advanced physiotherapy practitioner and orthopaedic consultant, physiotherapy led clinics [34] separate Orthopaedic clinics [7].…”

Section: Care Pathway Characteristicsmentioning

confidence: 99%

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

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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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“…Nurse practitioners, physiotherapists, and occupational therapists have the potential to expand their roles in the treatment of stable or non-surgical patients [ 13 ]. For example, a physiotherapist-led clinic has been explored as a means of providing care for patients who are unlikely to require surgery in the near future and for whom comprehensive conservative management may be a more appropriate option [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Optimizing the interprofessional workforce for centralized intake of patients with osteoarthritis and rheumatoid disease: case study

et al. 2015

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IntroductionThis case study was part of a larger programme of research in Alberta that aims to develop an evidence-based model to optimize centralized intake province-wide to improve access to care. A centralized intake model places all referred patients on waiting lists based on severity and then directs them to the most appropriate provider or service. Our research focused on an in-depth assessment of two well-established models currently in place in Alberta to 1) enhance our understanding of the roles and responsibilities of staff in current intake processes, 2) identify workforce issues and opportunities within the current models, and 3) inform the potential use of alternative providers in the proposed centralized intake model.Case descriptionOur case study included two centralized intake models in Alberta associated with three clinics. One model involved one clinic that focuses on rheumatoid disease. The other model involved two clinics that focus on osteoarthritis. We completed a document review and interviews with managers and staff from both models. Finally, we reviewed the scope of practice regulations for a range of health-care providers to examine their suitability to contribute to the centralized intake process of osteoarthritis and rheumatoid disease.Discussion and evaluationInterview findings from both models suggested a need for an electronic medical record and eReferral system to improve the efficiency of the current process and reduce staff workload. Staff interviewed also spoke of the need to have a permanent musculoskeletal screener available to streamline the intake process for osteoarthritis patients. Both models relied on registered nurses, medical office assistants, and physicians throughout their intake process. Our scope of practice review revealed that several providers have the competencies to screen, assess, and provide case management at different junctures in the centralized intake of patients with osteoarthritis and rheumatoid disease.ConclusionsUsing a broader range of providers in the centralized intake of osteoarthritis and rheumatoid disease has the potential to improve access and care specifically related to the assessment and management of patients. This may enhance the patient care experience and address current access issues.

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Implementation of a quality care management system for patients with arthritis of the hip and knee

Cited by 12 publications

References 7 publications

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

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

Optimizing the interprofessional workforce for centralized intake of patients with osteoarthritis and rheumatoid disease: case study

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