Project measurement

• Service information checklist
• List of outcome measures

Service information checklist

This service information check-list was developed as a by-product of the project. It is a possible starting point for those responsible for planning or introducing an outpatient musculoskeletal service.

It is acknowledged that in addition there may be other local or national information needing consideration. This information however, provides an initial dataset that will help build an evidence base for the service and provide the means to thoroughly describe its rationale (why?) and makeup (how?), the impact it has made and the outcomes achieved (so what?). It will also allow service leaders to examine the cost-effectiveness of the service and provide meaningful comparisons to support future developments.

General information

Description of the population the service area covers i.e. size, urban/rural, deprivation.

• Prevalence rates among the general population
• How the clinical condition/service area features in national or local health plans/strategies
• The evidence base including any professional or organisational standards relating to this condition ie CSP, NICE, SIGN.

Service information

If developing a completely new service, you should ensure that you have baseline information that relates to the year BEFORE the service was introduced to allow comparison and evaluation.

Baseline data

• Number of referrals made to orthopaedic services per annum by type i.e. spinal, peripheral joint, knee etc (include diagnostic codes if possible)
• Waiting times
• Source of referrals i.e. GP Open access, other sources
• Where the service is provided, ie location
• Who provides the service ie number and profession/ grade of staff (WTE)
• Gender and Age breakdown (use nationally defined age groups)
• Proportion of outpatient referrals that proceed to physiotherapy
• Proportion of outpatient referrals that proceed to surgery
• Re-referral rate.

Developing the service

• Training requirements for staff
• Competencies required including description of scope of practice ie level of experience, injection therapy, acupuncture, ability to order investigations, prescribing etc
• Referral and management guidelines/pathways developed
• Patient involvement in development process
• Patient Information
• Communication strategies with referrers and other key staff and patient groups
• Where the service is provided, i.e. location Who provides the service i.e. number and profession/ grade of staff (WTE)
• Time/s of day when the service operates
• Provide timescales for periods described. It is more usual to report figures based on yearly activity

Service description

• Waiting times
• Number of referrals made to service
• Number of referrals made to orthopaedic services per annum by type ie spinal, peripheral joint, knee etc (include diagnostic codes if possible)
• Source of referrals ie GP Open access, other sources?
• DNA at first appointment rate
• Gender and Age breakdown (use nationally defined age groups)
• Appropriateness of referral based on defined criteria
• Employment status & work absence
• Assessment tools used (validated?) include a measure of the patient’s perception of the severity of their problem
• Investigations undertaken including X-rays, scans, blood tests etc
• Management plan including type/s of intervention & information provided
• Number of total service contacts
• Discharge reason ie re-referred, intervention complete, failed to complete etc.

Outcomes

Use validated scales, if at all possible, if not, provide a reason. Record:

• A measure of outcome of intervention
• A measure of the patient’s perception of severity at discharge (if appropriate)
• The patient’s perception of the service, its acceptability and quality
• Professional Body/National organisation standards – level of achievement
• Work absence and/or status
• The proportion of outpatient referrals that proceed to surgery
• The impact made on the workload of others
• The impact made on the working lives/CPD of physiotherapists
• Re-referral rate
• Consider patient follow-up to provide a longer term view.

List of outcome measures