470 - Ontario Inter-professional Spine Assessment and Education Clinics (ISA...

Oral Posters: Innovative Technologies

Presented by: R. Rampersaud - View Audio/Video Presentation (Members Only)


R. Rampersaud(1), A. Bidos(2), S. Schultz(3), C. Fanti(4), B. Young(5), B. Drew(6), D. Puskas(7), D. Henry(3)

(1) University of Toronto, Surgery - Orthopaedics, Toronto, ON, Canada
(2) University Health Network, Toronto, ON, Canada
(3) Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
(4) Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
(5) Hamilton General Hospital, Hamilton, ON, Canada
(6) McMaster University, Surgery - Orthopaedics, Hamilton, ON, Canada
(7) Northern Ontario School of Medicine, Surgery - Orthopaedics, Thunder Bay, ON, Canada


Introduction: ISAEC uses an interdisciplinary shared-care model to provide upstream secondary and tertiary standardized clinical evaluation, stratified education and self-management recommendations for low back pain patients. ISAEC was designed to integrate care between ongoing patient self-management, primary care and specialist care including standardized imaging and referral criteria. The objectives of this study are to determine the impact of an evidenced based shared-care model of care (ISAEC) on
1) Patient reported satisfaction and outcome;
2) Primary care provider (PCP) satisfaction and knowledge transfer;
3) Surgical referral appropriateness; and
4) Utilization of spinal imaging from the perspective of the health care system.

Methods: 1) Mixed methods study for patient and provider evaluation (patient reported outcomes measures (Oswestry Disability Index (ODI) / Start Back Chronicity Risk Assessment) as well as process and satisfaction surveys).
2) Institute for Clinical Evaluative Sciences (ICES) administrative data analysis comparing spine imaging test ordering by ISAEC and non-ISAEC physicians and determine the direct cost impact.

Results: From November 2012 to February 2016, 4532 patients have been assessed. The mean wait time for secondary assessment was 12 days. The majority of patients (68%) were diagnosed with back-dominant pain. The majority of presentations (68%) were considered complex (e.g. positive for psychosocial factors (52.2%)). Patient satisfaction (n=1922) was 99%, and 95% felt they understood their condition better. For 811 patients enrolled in a longitudinal study, 54% of patients reported a perceived improvement in their symptoms with a mean reduction in ODI score of 10 was observed at 6 months (Baseline=36% / 6 months=26%). At 4 and 12 months into the program, enrolled PCPs (n=134 /220) on average showed a two-fold increase in their confidence managing LBP (assessment and management, referral for imaging and specialist consultation). 97% of PCPs reported overall satisfaction with the ISAEC model of care and felt that ISAEC services would be useful to all PCPs. Within the ISAEC network of providers, surgical referral appropriateness was 96% (compared to 20-30% prior to ISAEC) and < 4% of overall ISAEC patients have gone on to surgical interventions. Average wait-time for surgical assessment was 5.4 weeks, 4.3 weeks, and 2.2 weeks at the metropolitan, urban, and rural centres respectively compared to 6-18 month prior to formation of the ISAEC network. Compared to non-ISAEC PCPs, the overall annual utilization for all LBP-related diagnostic imaging ordered by ISAEC-PCPs fell 28% in year 1 and an additional 5% in year 2 compared to their non-ISAEC peers. This translated to an annual estimated per physician cost avoidance of $3150 and $4175 in year 1 and 2 respectively based only on imaging.

Conclusion: In single-payer public healthcare delivery system, a shared-care, stratified education and self-management model of care for LBP provides significant positive multidimensional impact on patients, providers and the health care system. Overall, the ISAEC model was able to improve on the quality and appropriateness of care, while reducing cost.