Funding: The project was supported by funding from the Commonwealth of Australia, Department of Health and Ageing, and the Royal Australasian College of Physicians through the Arthritis and Musculoskeletal Quality Improvement Program (AMQuIP). There was internal funding support from the Royal Melbourne Hospital with redefinition and repositioning of a physiotherapist from the allied health department to the musculoskeletal coordinator position in the rheumatology clinic.
Redesigning care for chronic conditions: improving hospital-based ambulatory care for people with osteoarthritis of the hip and knee
Version of Record online: 23 MAR 2009
© 2010 The Authors. Journal compilation © 2010 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 40, Issue 6, pages 427–436, June 2010
How to Cite
Brand, C. A., Amatya, B., Gordon, B., Tosti, T. and Gorelik, A. (2010), Redesigning care for chronic conditions: improving hospital-based ambulatory care for people with osteoarthritis of the hip and knee. Internal Medicine Journal, 40: 427–436. doi: 10.1111/j.1445-5994.2009.01960.x
Conflict of interest: None.
- Issue online: 15 JUN 2010
- Version of Record online: 23 MAR 2009
- Received 13 October 2008; accepted 1 March 2009.
- chronic disease management;
- quality improvement
Background: Osteoarthritis of the hip and knee is a highly prevalent chronic condition in Australia that commonly affects older people who have other comorbidities. We report the pilot implementation of a new chronic disease management osteoarthritis service, which was multidisciplinary, evidence-based, supported patient self-management and care coordination.
Methods: A musculoskeletal coordinator role was pivotal to service redesign and osteoarthritis pathway implementation. Impact evaluation included: service utilization, patient and general practitioner service experience, a ‘before and after’ audit of clinician adherence to recommendations, and 3- and 6-month patient health outcomes (pain, physical function, patient and physician global health (Visual Analogue Scale), disability (Multi-Attribute Prioritisation Tool), Partners in Health Scale and body mass index).
Results: A total of 123 patients, median age of 66 years, were assessed. Documentation of osteoarthritis assessment and management improved for all parameters. At 3 months there were improvements in self-reported pain (P < 0.001), global function (P < 0.001), physician and patient reported global health (P < 0.001), Partners in Health Score (P < 0.001) and Hip and Knee Multi-Attribute Prioritisation Tool score (P < 0.014). Body mass index did not improve. Patients and general practitioners reported positive experiences, but there was variable uptake of recommendations by patients. The main factors influencing uptake of recommendations were access block to community services in the first 3 months and patient preferences for therapy. The cost implications for implementation were low.
Conclusion: The osteoarthritis service model is feasible to implement, is well received by patients and staff, and provides a template for translation into other settings.