Benchmarking community/primary care musculoskeletal services: A narrative review and recommendation

Abstract

Introduction: High quality data on service performance is essential in healthcare to evidence efficacy, efficiency, and value. There remains a paucity of publicly reported data in community and primary care musculoskeletal (MSK) services. There is also a lack of guidance on which metrics MSK services should be collecting and reporting, and how this data could be used to directly improve patient outcomes, experiences, and value.Method: A narrative review of the evidence around benchmarking MSK services was undertaken with a focus on how to develop routine data collection within community/primary care settings, and how to develop benchmarking capabilities for the future, looking towards a national MSK audit. This evidence was triangulated with the findings from recent MSK data studies undertaken by the authors and emerging UK policy and guidance in this area. Recommendations:To enable MSK benchmarking services need to collect consistent, standardised outcomes and, therefore, we have developed a recommendation on a minimum MSK 'core outcome set' of Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) (PROMs: MSK-HQ, NPRS, WPAI; PREMs: National MSK PREM). In addition, we make recommendations on the use of a standardised evidence-based method for case-mix adjustment and outlier identification (using the following baseline demographics and clinical factors; age, sex, ethnicity, pain site, comorbidities, duration of symptoms, previous surgery, previous pain episodes), alongside considerations on how this data should be integrated and reported within NHS systems. Conclusions:Capturing high quality MSK data in a standardised, consistent, and sustainable way is a significant challenge. Policy holders, commissioners, managers, and clinicians need to be realistic with expectations, and take time to explore barriers to implementation including, funding, digital infrastructure/intra-operability, data sharing/governance, digital literacy, and local/national leadership. Next steps include developing a national MSK audit programme to provide a benchmarking model to support continuous improvements in care quality for patients living with MSK conditions.

Minimal clinical datasets for spine-related musculoskeletal disorders in primary and outpatient care settings: a scoping review

“…Feasibility of use of a minimal clinical dataset in busy routine clinical practice is a key consideration, but less than half (47%) of the datasets provided information on their implementation or feasibility in routine clinical care. To ensure the effective adoption of minimal clinical datasets for patients with spine-related MSK disorders in routine clinical practice, it is essential to involve all relevant stakeholders in the development process [16]. We found that 69% of the datasets engaged end-users, but healthcare professionals and patients were only involved in 50% and 28%, respectively.…”

“…Such a dataset should be developed to collect and compare data across different treatment pathways and bridge the gap between outcomes feasible for use in routine clinical practice, quality improvement, benchmarking, and feedback initiatives [14,15]. Engagement of patients, clinicians, and other end-users in the development process is crucial for successful implementation of minimal clinical datasets and to ensure its relevance and acceptability [16]. To be practical and to minimize response burden, they should be as brief as possible and easy to interpret [17].…”

Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey

“…Reasons for this discord range from lack of clinician knowledge regarding how to advise on recommended treatments not taught in medical school to time constraints that limit their ability to delve into the psychosocial issues often associated with spine-related disorders [ 16 , 53 , 54 ]. Benchmarking and other health system-level strategies to improve care quality in musculoskeletal service delivery require additional research [ 40 , 55 ]. The prospect of changing practice habits is shown to be higher when decisions are supported by health systems with measures like payment adjustments, order restrictions, and the development of EHR integration for clinician guidance [ 56 , 57 ].…”

Revised service metrics partially explain variation in outcomes across facilities in a state‐wide advanced practice public musculoskeletal service

“…Overall the findings of this study further highlight challenges in capturing relevant, high quality musculoskeletal data. Yet in the interests of patient care, continual refinement of service metrics remains a priority to permit meaningful benchmarking (Burgess et al., 2022) not only within multi‐facility services such as the N/OPSC&MDS, but also between musculoskeletal services nationally and internationally.…”

“…In this situation it is recommended that potential sources of variation between facilities are identified to better inform future serve planning, ensuring equitable and efficient provision of care (ACSQHC, 2013; Partington et al., 2017). This can be challenging in musculoskeletal care as systems and processes for meaningful benchmarking of musculoskeletal services are in their infancy (Burgess et al., 2022) One example of a musculoskeletal service recently reported to have variation in outcomes across its numerous facilities is the Neurosurgical and Orthopaedic Physiotherapy Screening Clinic and Multi‐disciplinary Service (N/OPSC&MDS) (Raymer et al., 2021).…”