Paula Harding1, Angela Burge2, Kerrie Walter3, Bridget Shaw4, Carolyn Page5, Uyen Phan6, Desiree Terrill7, Susan Liew8. 1. The Alfred, 55 Commercial Road, Melbourne, 3004 VIC, Australia. Electronic address: p.harding@alfred.org.au. 2. The Alfred, 55 Commercial Road, Melbourne, 3004 VIC, Australia. Electronic address: a.burge@alfred.org.au. 3. The Alfred, 55 Commercial Road, Melbourne, 3004 VIC, Australia. Electronic address: k.walter@alfred.org.au. 4. St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, VIC, Australia. Electronic address: Bridget.shaw@svha.org.au. 5. St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, VIC, Australia. Electronic address: Carolyn.page@svha.org.au. 6. Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, Australia. Electronic address: Uyen.Phan@mh.org.au. 7. Department of Health and Human Services, 50 Lonsdale Street, Melbourne, VIC, Australia. Electronic address: Desiree.Terrill@dhhs.vic.gov.au. 8. The Alfred, 55 Commercial Road, Melbourne, 3004 VIC, Australia. Electronic address: s.liew@alfred.org.au.
Abstract
OBJECTIVE: To evaluate outcomes following a state-wide implementation of post arthroplasty review (PAR) clinics for patients following total hip and knee arthroplasty, led by advanced musculoskeletal physiotherapists in collaboration with orthopaedic specialists. DESIGN AND SETTING: A prospective observational study analysed data collected by 10 implementation sites (five metropolitan and five regional/rural centres) between September 2014 and June 2015. MAIN OUTCOME MEASURES: The Victorian Innovation and Reform Impact Assessment Framework was used to assess efficiency, effectiveness (access to care, safety and quality, workforce capacity, utilisation of skill sets, patient and workforce satisfaction) and sustainability (stakeholder engagement, succession planning and availability of ongoing funding). RESULTS: 2362 planned occasions of service (OOS) were provided for 2057 patients. Reduced patient wait times from referral to appointment were recorded and no adverse events occurred. Average cost savings across 10 sites was AUD$38 per OOS (Baseline $63, PAR clinic $35), representing a reduced pathway cost of 44%. Average annual predicted total value of increased orthopaedic specialist capacity was $11,950 per PAR clinic (range $6149 to $23,400). The Australian Orthopaedic Association review guidelines were met (8/10 sites, 80%) and patient-reported outcome measures were introduced as routine clinical care. High workforce and patient satisfaction were expressed. Eighteen physiotherapists were trained creating a sustainable workforce. Eight sites secured ongoing funding. CONCLUSIONS: The PAR clinics delivered a safe, cost-efficient model of care that improved patient access and quality of care compared to traditional specialist-led workforce models. Crown
OBJECTIVE: To evaluate outcomes following a state-wide implementation of post arthroplasty review (PAR) clinics for patients following total hip and knee arthroplasty, led by advanced musculoskeletal physiotherapists in collaboration with orthopaedic specialists. DESIGN AND SETTING: A prospective observational study analysed data collected by 10 implementation sites (five metropolitan and five regional/rural centres) between September 2014 and June 2015. MAIN OUTCOME MEASURES: The Victorian Innovation and Reform Impact Assessment Framework was used to assess efficiency, effectiveness (access to care, safety and quality, workforce capacity, utilisation of skill sets, patient and workforce satisfaction) and sustainability (stakeholder engagement, succession planning and availability of ongoing funding). RESULTS: 2362 planned occasions of service (OOS) were provided for 2057 patients. Reduced patient wait times from referral to appointment were recorded and no adverse events occurred. Average cost savings across 10 sites was AUD$38 per OOS (Baseline $63, PAR clinic $35), representing a reduced pathway cost of 44%. Average annual predicted total value of increased orthopaedic specialist capacity was $11,950 per PAR clinic (range $6149 to $23,400). The Australian Orthopaedic Association review guidelines were met (8/10 sites, 80%) and patient-reported outcome measures were introduced as routine clinical care. High workforce and patient satisfaction were expressed. Eighteen physiotherapists were trained creating a sustainable workforce. Eight sites secured ongoing funding. CONCLUSIONS: The PAR clinics delivered a safe, cost-efficient model of care that improved patient access and quality of care compared to traditional specialist-led workforce models. Crown
Authors: Simon Lafrance; Anthony Demont; Kednapa Thavorn; Julio Fernandes; Carlo Santaguida; François Desmeules Journal: BMC Health Serv Res Date: 2021-11-09 Impact factor: 2.908