Update from Bone and Joint Decade Canada

James P. Waddell, M.D., FRCSC
Coordinator, Canadian National Action Network
For the Bone and Joint Decade

Rhona McGlasson, RPT, MBA
Project Coordinator for the Bone and Joint Health Network
Sunnybrook, Holland Centre

Hazel Wood, BSc OT, MBA
Executive Director
Bone and Joint Decade Canada

For the past two years, Bone and Joint Canada has been working with orthopaedic surgeons across Canada to develop a strategy to address wait times for hip and knee replacement surgery. This initiative is being led by the provinces that have implemented successful models of care over the last few years. These initiatives include Alberta, where a randomized control trial was implemented that proved it possible to improve access to care while improving the quality of care. In Ontario, a model was launched in Toronto which resulted in reducing the average wait time from surgeon to surgery down to two months, while improving consistency of care. This model uses advanced practice therapists in an effort to better coordinate care as well as reduce the cost. Through the implementation of central intake, coordinated care and OR efficiencies, BC has reduced wait times and improved consistency of care. Other models across the country which have begun more recently have also started to improve care for patients requiring hip and knee replacement surgery. Furthermore, the programmes in Alberta, Ontario and BC have started to expand their concepts to other areas of MSK where wait times for care continue to be an issue.

As such, on April 4-5, 2008, Bone and Joint Canada partnered with the Alberta Bone and Joint Health Institute to launch the development of the Canadian Knowledge Translation (KT) Model for Musculoskeletal Care (CANCARE). Key opinion leaders from across the country including representatives from orthopaedics, rheumatology, hospital administration and government came together to provide an overview of activities within each province and to help guide the development of the KT Network with the eventual goal of creating a National Model of care for hip and knee replacement patients which is adaptable to meet local needs of communities.

The group identified the core elements and principles that would be required for a National Model of care including:

• fair and equitable treatment across the continuum of care;
•  transdisciplinary care;
• application of an evidence-based model;
• optimization of health human resources;
• reduction of duplication;
• identification of a minimum data set;
• accountability that addresses quality and safety,
• system-wide outcomes and appropriateness of interventions.

The need for access, quality and efficiency in order to successfully address wait times for hip and knee replacement surgery was noted.

To date, some of the most effective means of affecting access have been through the use of central intake, triaging, comprehensive assessments, allocation to first available surgeon, and the use of advanced practice therapists and physician assistants. Quality has been positively affected through the consistent use of Care Maps, patient and family education, and accountability. Efficiencies have been realized by improving and monitoring processes throughout the continuum of care (preop, OR and postop into community). Information management and technology is expected to further improve efficiency.

It was also noted that the model must address the needs of non-surgical hip and knee patients to ensure appropriate nonoperative care, referral to other health providers and specialists e.g. rheumatology and re-access to the system when a patient becomes a surgical candidate. As such, the model needs to be for all hip and knee arthritis and align with other relevant initiatives such as regional chronic disease management initiatives and rheumatology for inflammatory and osteoarthritis. There are also significant opportunities to explore the use of this model in the management of other MSK populations that experience extensive wait time issues. The final vision of the Knowledge Translation Group must be comprehensive access to orthopaedic care across Canada.

The Knowledge Translation Group left with a mandate of creating documents to assist each province in producing and implementing a successful programme for hip and knee arthritis. This will include a report and a tool kit. Over the coming year, we expect to have another meeting to further discuss the development of the Canadian Knowledge Translation Network for MSK Care. You can look forward to a more detailed update following that meeting.

It was agreed that we need to invest, reward and celebrate successes.