What does high value care for musculoskeletal conditions mean and how do you apply it in practice? A consensus statement from a research network of physiotherapists in New South Wales, Australia

Abstract

ObjectivesTo develop a physiotherapist-led consensus statement on the definition and provision of high-value care for people with musculoskeletal conditions.DesignWe performed a three-stage study using Research And Development/University of California Los Angeles Appropriateness Method methodology. We reviewed evidence about current definitions through a rapid literature review and then performed a survey and interviews with network members to gather consensus. Consensus was finalised in a face-to-face meeting.SettingAustralian primary care.ParticipantsRegistered physiotherapists who are members of a practice-based research network (n=31).ResultsThe rapid review revealed two definitions, four domains of high value care and seven themes of high-quality care. Online survey responses (n=26) and interviews (n=9) generated two additional high-quality care themes, a definition of low-value care, and 21 statements on the application of high value care. Consensus was reached for three working definitions (high value, high-quality and low value care), a final model of four high value care domains (high-quality care, patient values, cost-effectiveness, reducing waste), nine high-quality care themes and 15 statements on application.ConclusionHigh value care for musculoskeletal conditions delivers most value for the patient, and the clinical benefits outweigh the costs to the individual or system providing the care. High-quality care is evidence based, effective and safe care that is patient-centred, consistent, accountable, timely, equitable and allows easy interaction with healthcare providers and healthcare systems.

Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review

“… 11 , 12 Persistent implementation of such treatments has given rise to the concept of “low-value” physiotherapy, which yields little or no benefit relative to cost, or where the risk of adverse impact is greater than the likelihood of benefit. 13 Conversely, a recent consensus statement from Australian physiotherapists defined “high-value” physiotherapy (HVP) as “care that delivers most value for the patient, and the clinical benefits outweigh the costs to the individual or system providing the care” 14 (p. 4). As a recent concept, 15 HVP is often considered interchangeable with evidence-based practice (EBP).…”