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Enhancing clinical and economic outcomes. Physiotherapy Screening & MD Management in Orthopaedics and Neurosurgery. David Smith, Maree Raymer David_Smith@health.qld.gov.au 0407 767 632 SOPD Innovation Workshop Wednesday 27 th November 2013. Significance of MSK conditions.

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enhancing clinical and economic outcomes
Enhancing clinical and economic outcomes

Physiotherapy Screening & MD Management in Orthopaedics and Neurosurgery

David Smith, Maree Raymer

David_Smith@health.qld.gov.au 0407 767 632

SOPD Innovation Workshop

Wednesday 27th November 2013

significance of msk conditions
Significance of MSK conditions

31% of Australians

Disability & productivity loss

$4.1 billion

4th largest contributor to direct health costs (2004/2005)

slide3

Non-operative

Management

eg. PT, ongoing

R/V

Triage

(Cat 1,2,3)

Elective Surg.

Wait List

(Cat 1,2,3)

Initial

SOPD

Consult

GP

Referral

SOPD

Wait List

(Ortho or N/S)

Discharge

to GP

Traditional Pathway (Ortho or N/Surg)

10-25%

  • High demand – needs poorly met
  • ~60% not seen in time
  • Poor QoL & deterioration while wait
  • Most patients don’t need surgery
  • Inefficiency
slide4

Physio. Screening & MD management

Non-operative

Management

eg. PT, ongoing

R/V

Triage

(Cat 1,2,3)

Elective Surg.

W.List

(Cat 1,2,3)

Initial

SOPD

Consult

GP

Referral

SOPD

Wait List

Deliver

Select

Discharge

to GP

Physiotherapy

Screening

Clinic

Redirect

MD

Non–surgical

Management

n opsc mds outcomes
N/OPSC & MDS Outcomes

Services established State wide

- 13 facilities Orthopaedics, 4 N/Surgery

Activity (FY13) :5 532 new(4837 R/V)

Management : 72% Referred to

Non surgical Mx

Waitlist

Reductions : 27 – 54%

12%

Managed, & Removed

Wait list

65%

discharge patterns
Discharge Patterns

Remain SOPD waitlist

Urgency ISQ

Managed & removed SOPD wait list

23%

65%

12%

Urgency Upgraded

Safety Net

red flags
Red Flags

Significant pathologies identified

(> 40 in a sample between 2008 & 2012)

  • Neoplasms
      • spinal, soft tissue, pelvic
      • lung, thyroid
  • Fractures – hip and pelvis
  • Auto immune conditions and Inflammatory conditions incl. MS
  • Cerebral Vascular anomalies
  • Sub-arachnoid cysts
  • Cord Compression req. emergency decompression.
  • Parkinson’s Disease
research projects to maximise effectiveness
Research Projects to maximise effectiveness

Project 1 : Optimising patient selection

: develop a prediction model to identify early those patients likely to be successful or unsuccessfulwith non surgical management

Project 2 : Cost effectiveness analysis

: fully informed cost effectiveness analysis and identification of the optimal mix of services between traditional and physiotherapy led service model

progress economic analysis
Progress : economic analysis

Pilot study completed

OPSC & MDS model likely to be highly cost effective

Results tempered by uncertainty in some parameters

Prospective study required to apply this economic model in a fully informed prospective analysis

Prospective multi - site study underway

√ Grant funding awarded (AusHSI)

√ Central and site specific ethics approvals in place

√ Patient Recruitment underway with > 400 patients enrolled

summary to date
Summary to date

N/OPSC & MDS = expert physiotherapy assessment (advanced role) and comprehensive MD management for selected Cat 2 & 3 patients

Well established in 13 facilities in Orthopaedics and 4 Neurosurgery – delivering > 5 500 new SOPD app’ts p.a.

Overall very well received by surgeons, GP’s and patients

Patient outcomes and health system benefits clearly demonstrated

→ more timely, efficient and cost effective services which maximise value of the workforce

lessons learned
Lessons Learned

The patient and planning

  • Placing patient experience & patient choices at centre of planning, both for flow and treatment options.
  • Tangible patient benefits have to be demonstrated.
  • Abiding by guiding principles helps check direction & integrity when changes may be demanded.

Support

  • Sustained Executive buy-in essential : actions > words.
  • Ongoing Executive support required to overcome barriers and resistance to change.
  • Continual advocacy and networking for success.
  • Executive doesn’t stop at HHS but also Systems Manager.
lessons learned cont d
Lessons Learned cont’d

Innovation and problem solving

  • Willingness to work backwards from a problem to a solution with a blank page vs more of the same.
  • Understanding the problem from its root cause more important than focussing on the secondary effects or barriers.
  • Taking a good idea and making better is innovation.

Workforce

  • Enabling staff to work towards full potential is extremely motivating; helps to maximise value of both physiotherapy and medical workforce.
  • Ongoing workforce development required for sustainability and expansion.
  • Higher level roles/responsibilities demand advanced/ higher level skills.
lessons learned cont d1
Lessons Learned cont’d

Measures, data & relevance

  • Reporting measures that are meaningful across a range of domains resonate with different stakeholders eg. patient outcomes, stakeholder impacts, organisational and cost impacts.
  • Data collection built in.
  • Understand different stakeholders have different motivating factors for success.
  • KPI’s aligned with funding and priorities.

Continuous improvement & change management

  • Building in an ethos of continual improvement and flexible responsiveness to changing environment is essential.
  • Resourcing for improvement and research is critical.
  • Must be able to adapt to changing political environment, (both small p and big P) – opportunities and challenges.
  • If something no longer works – accept it, make it work or make any necessary change.
slide15

Opportunities

Demand > N/OPSC capacity = scope for expansion at existing sites to better match patient need

Sites that currently don’t have this model could adopt & benefit

Cost efficiency potential

Broader MSK service reform -

Adopt similar approach to Chronic pain, Rheumatology

Other 1st contact models: ED, Urology/Gynae etc

Challenges

Not working to full scope –– enable and progress to extended scope incl. access to imaging, pathology and prescribing

How to best work/integrate with ML’s

Inconsistent application of triaging and integration of N/OPSC with medically led clinics in SOPD

Changing perceptions re: timing and role of referral to SOPD

VMO factor

Regional/Rural service access

Workforce supply and skills development

National Categorisation Guidelines

David_Smith@health.qld.gov.au 0407 767 632