Ms Maree Raymer1, Dr Louise Mitchell2, Associate Professor Tracy Comans3, Dr Peter Window1, Dr Shaun O’Leary1,3
1Metro North Hospital And Health Service, Herston, Brisbane, Australia, 2Department of Health, Brisbane, Australia, 3University of Queensland, Brisbane, Australia
Background: Advanced practice physiotherapy screening clinics are embedded in most Orthopaedic and Neurosurgery Specialist Outpatient services in Queensland. This study aimed to 1) describe service pathway and patient reported clinical outcomes for a large cohort of patients state-wide and 2) identify and understand variation in outcomes between facilities and clients.
Method: Routinely collected demographic, service and patient reported outcome data for 29,319 clients managed across 15 facilities between April 2012 and April 2017 were extracted from the N/OPSC Measurement Analysis and Reporting System. Descriptive statistics were calculated. Independent sample t-tests, ANOVA, and Chi-Square tests were undertaken to explore differences in pathway outcomes by client and service characteristics. Regression models were used to explore variation between facility and client characteristics.
Results: Across the state-wide service, improvements in pain, function and disability outcomes at discharge exceeded clinically relevant thresholds (p < 0.01), with 69.4% of patients removed from Specialist Outpatient waitlists without medical consultation. Variations in this rate were observed between clinical sites as well as between the different conditions managed (e.g. spine, knees) (p < 0.001). Subsequent regression modelling demonstrated that even after adjusting for the condition managed and known patient characteristics, variation in the rate of patients removed from waitlists still existed between sites.
Discussion: Most patients managed in Neurosurgery and Orthopaedic Physiotherapy Screening Clinics in Queensland achieve clinically important outcomes and are removed from the wait list without requiring medical consultation. However, there is some variation in these clinical and service metrics between clinic sites which is not explained by available patient and service information. Findings of this study have subsequently informed revision of standardised data collection to incorporate a larger range of patient and service related variables. A better understanding of variation in outcomes between services will inform state wide continuous improvement in advanced practice physiotherapy services.
Maree Raymer has post graduate qualifications in Musculoskeletal Physiotherapy and Health Service Management. As the State wide Program Manager for Physiotherapy Screening Clinics in Orthopaedics and Neurosurgery in Queensland she leads research, education and service improvement initiatives.