Utilization and cost of a new model of care for managing acute knee injuries: the Calgary acute knee injury clinic

Abstract

BackgroundMusculoskeletal disorders (MSDs) affect a large proportion of the Canadian population and present a huge problem that continues to strain primary healthcare resources. Currently, the Canadian healthcare system depicts a clinical care pathway for MSDs that is inefficient and ineffective. Therefore, a new inter-disciplinary team-based model of care for managing acute knee injuries was developed in Calgary, Alberta, Canada: the Calgary Acute Knee Injury Clinic (C-AKIC). The goal of this paper is to evaluate and report on the appropriateness, efficiency, and effectiveness of the C-AKIC through healthcare utilization and costs associated with acute knee injuries.MethodsThis quasi-experimental study measured and evaluated cost and utilization associated with specific healthcare services for patients presenting with acute knee injuries. The goal was to compare patients receiving care from two clinical care pathways: the existing pathway (i.e. comparison group) and a new model, the C-AKIC (i.e. experimental group). This was accomplished through the use of a Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ).ResultsData from 138 questionnaires were analyzed in the experimental group and 136 in the comparison group. A post-hoc analysis determined that both groups were statistically similar in socio-demographic characteristics. With respect to utilization, patients receiving care through the C-AKIC used significantly less resources. Overall, patients receiving care through the C-AKIC incurred 37% of the cost of patients with knee injuries in the comparison group and significantly incurred less costs when compared to the comparison group. The total aggregate average cost for the C-AKIC group was $2,549.59 compared to $6,954.33 for the comparison group (p <.001).ConclusionsThe Calgary Acute Knee Injury Clinic was able to manage and treat knee injured patients for less cost than the existing state of healthcare delivery. The combined results from this study show that the C-AKIC is an appropriate, effective, and efficient model of clinical care for patients presenting with acute knee injuries.

The use of magnetic resonance imaging in acute knee injuries can be reduced by non-physician expert clinics

“…Given that the average cost of a knee MRI in Alberta is $540 [27], ordering fewer MRIs by having patients with acute knee injuries assessed in a clinic like the AKIC could achieve a cost-saving of $86,400 per 1000 patients with knee injuries. These results support those of a previous study by Lau et al which showed that AKIC patients had lower MRI utilization rates and made less visits to their primary care physician, to the emergency department, as well as to specialists, thus resulting in a 63% decrease in overall patient care costs [25].…”

“…More general clinicians are relying on advanced imaging to provide a diagnosis, thus driving uncontrolled costs and a non-sustainable system of care. The AKIC model of utilizing NPEs is a viable, timely, and cost-effective alternative to the current practice [25,26].…”

“…The NPE is an athletic therapist who is trained at a competency level equivalent to an orthopedic specialist but only in the evaluation of knee injuries [25,26]. This multidisciplinary approach utilizing state-of-the-art web-based screening has been shown to improve access, reduce wait times, and increase patient satisfaction [25]. This model has also proved to be less costly than the existing system, with significant cost savings related to decreased MRI utilization [26].…”

“…The AKIC is a specialized clinic where patients with knee injuries are assessed by a team consisting of a non-physician expert (NPE) and a certified sport medicine physician (SMP). The NPE is an athletic therapist who is trained at a competency level equivalent to an orthopedic specialist but only in the evaluation of knee injuries [25,26]. This multidisciplinary approach utilizing state-of-the-art web-based screening has been shown to improve access, reduce wait times, and increase patient satisfaction [25].…”

Diagnostic validity and triage concordance of a physiotherapist compared to physicians’ diagnoses for common knee disorders

“…Knee disorders are a common reason for seeking diagnosis and management in primary care and can significantly impact quality of life of individuals [ 1 – 3 ]. However, evidence shows the limited ability of medical providers to perform an appropriate physical examination to make a diagnosis [ 4 , 5 ]. This has led to an overreliance on imaging or inappropriate referral to specialists to confirm a diagnosis, which incurs increasing health care costs and unnecessary delays to initiate conservative care [ 4 – 8 ].…”