Ensuring that patients get the right care, at the right place, and at the right time is important to provide excellent care and optimize health system performance. Quality-Based Procedures Clinical Handbooks, developed by expert advisory panels, provide best-practice recommendations for patient care across several diseases, conditions and procedures. Many of these handbooks, including the Clinical Handbook for Degenerative Disorders of the Shoulder, recommend a team-based approach to optimize patient care.
Health Quality Ontario had a chance to catch up with Dr. Helen Razmjou, advanced practice physiotherapist (APP) at Sunnybrook’s Holland Orthopaedic and Arthritic Centre, to talk about how her Centre’s team-based model of care is advancing best practices for degenerative disorders of the shoulder.
In this photo: Helen Razmjou, B.Sc. PT, MS., PhD, Sunnybrook Health Sciences Centre, Holland Orthopedic and Arthritic Centre, Department of Rehabilitation. She is an expert panelist on the Quality-Based Procedure: Clinical Handbook for Degenerative Disorders of the Shoulder.
Can you describe the team-based model of care used for shoulder conditions at the Holland Centre?
At the Holland Centre, physiotherapists are selected and trained to become advanced practice physiotherapists (APP) for shoulder conditions. They hold advanced degrees and are trained through a 3-month residency program.
APPs assess patients with rotator cuff, osteoarthritis and labral pathologies of the shoulder who have been referred to surgeons in the Shoulder Specialty Clinic. They provide education, create a management plan and provide post-operative follow-up.Our team consists of the APP’s, Surgeons and Radiologists.
Why did the Holland Centre include APPs as part of their model of care?
The Holland Centre first initiated a similar team-based model of care for patients with hip and knee arthritis.Due to the positive results, such as reduced wait times, and the desire to expand this model of care, there was a need to investigate if similar results would be obtained for patients with shoulder conditions.
In 2013, I co-authored a research paper called Evaluation of an Advanced-Practice Physical Therapist (APP) in a Specialty Shoulder Clinic: Diagnostic Agreement and Effect on Wait times as part of a Primary Care Series for Physiotherapy Canada.
The main results of the study demonstrated that:
- Patient wait times for shoulder care were reduced
- Patient satisfaction was high in all components of care received from both APPs and orthopedic surgeons
- There was good to excellent agreement on major diagnostic categories between APPs and orthopedic surgeons
- There was good agreement with respect to indication for surgery between APPs and surgeons
The research concluded that using APPs reduces wait times without compromising patient clinical management and satisfaction. Ongoing research by the Shoulder APP team at the Holland Centre has shown the value of a team-based model of care. In addition, numerous studies have supported the effectiveness, safety, cost reduction and improved patient satisfaction associated with using APPs in musculoskeletal (MSK) care.
How does this research align with the Clinical Handbook for Degenerative Disorders of the Shoulder?
The clinical handbook is driven by clinical evidence and best practice recommendations from the Clinical Expert Advisory Groups which I was a member of in 2015. The above study was the first study in Canada that examined agreement between an orthopedic surgeon and an APP specialized in shoulder assessment.
Our research demonstrates that the APP role can help deliver the objectives of the Clinical Handbook by ensuring our patients have:
- Timely and accurate diagnosis including appropriate use of diagnostic imaging of the shoulder
- Access to and use of non-surgical approaches (e.g. anti- inflammatory medications, physiotherapy) to conservatively manage degenerative disorders of the shoulder
- Appropriate and standardized referral to specialty care for complex degenerative disorders of the shoulder that are unresponsive to conservative management
- An evidence-based approach to surgery to optimize outcome
Would you like to see APPs used for other conditions?
Yes! We’d love to see this model of care with APPs continue to grow and spread through the province.
Are you working to implement Quality Based Procedures? Add your comments or questions below or reach out to Helen on Quorum.