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Table 1 Definitions of optimal and suboptimal treatment outcomes per clinic type

From: Using routine referral data for patients with knee and hip pain to improve access to specialist care

Combination of outcomesOptimal/ suboptimal outcome combinations
Specialist GP clinicAdvanced physiotherapy practitioner clinicOrthopaedic clinic
Single outcomes
 ConsultantaSub-optimalasub-optimalasub-optimala
 Physioboptimalboptimalbsub-optimalb
 Dieticianboptimalboptimalbsub-optimalb
 Monitoringcsub-optimalcsub-optimalcsub-optimalc
 Surgerydsub-optimaldsub-optimaldoptimal
 Imagingeoptimaleoptimalesub-optimale
 Injectioneoptimaleoptimalesub-optimale
 Dischargedfoptimalfoptimalfoptimalf
Multiple outcomes
 Consultant & imagingksub-optimalksub-optimalksub-optimalk
 Consultant & injectionksub-optimalksub-optimalksub-optimalk
 Consultant & physioksub-optimalksub-optimalksub-optimalk
 Dietician & dischargedmsub-optimalmsub-optimalmsub-optimalm
 Dietician & Imagingioptimalioptimalioptimali
 Dietician & injectionioptimalioptimalioptimali
 Dietician & injection & dischargedioptimalioptimalioptimali
 Dietician & monitoringgsub-optimalgsub-optimalgsub-optimalg
 Discharged & other specialityhoptimalhoptimalhoptimalh
 Imaging & dischargednoptimalnoptimalnoptimaln
 Imaging & injectionioptimalioptimalioptimali
 Imaging & other specialitygsub-optimalgsub-optimalgsub-optimalg
 Injection & dischargednoptimalnoptimalnoptimaln
 Injection & other specialitygsub-optimalgsub-optimalgsub-optimalg
 Monitoring & imaginggsub-optimalgsub-optimalgsub-optimalg
 Monitoring & imaging & injectiongsub-optimalgsub-optimalgsub-optimalg
 Monitoring & injectiongsub-optimalgsub-optimalgsub-optimalg
 Monitoring & other specialitygsub-optimalgsub-optimalgsub-optimalg
 Physio & dietician & dischargednoptimalnoptimalnoptimaln
 Physio & dietician & injectionioptimalioptimalioptimali
 Physio & dietician & monitoringgsub-optimalgsub-optimalgsub-optimalg
 Physio & dischargednoptimalnoptimalnoptimaln
 Physio & imagingioptimalioptimalioptimali
 Physio & imaging & injectionioptimalioptimalioptimali
 Physio & injectionioptimalioptimalioptimali
Physio & monitoringgsub-optimalgsub-optimalgsub-optimalg
 Physio & monitoring & imaginggsub-optimalgsub-optimalgsub-optimalg
 Physio & monitoring & injectiongsub-optimalgsub-optimalgsub-optimalg
 Physio & monitoring & otherspecialitygsub-optimalgsub-optimalgsub-optimalg
 Physio & otherspecialityloptimalloptimalloptimall
 Physio & surgeryloptimalloptimalloptimall
Surgery & imagingloptimalloptimalloptimall
  1. SINGLE OUTCOMES:
  2. aConsultant outcome is sub-optimal for all clinic types because it introduces an additional referral, adding a superfluous step in the pathway
  3. bPhysio or Dietician are sub-optimal outcomes for orthopaedic clinic only because of backtracking to a specialist clinician in non-surgical treatments rather than referring to them directly from primary care
  4. cMonitoring is sub-optimal for all clinic types as it creates additional consultation
  5. dSurgery is sub-optimal for advanced physiotherapy practitioner and specialist GP as better resource use would be to refer to an orthopaedic clinic directly
  6. eImaging and injection were not routinely available to General Practitioner referrers. They were considered optimal outcomes in advanced physiotherapy practitioner or specialist GP, but not for orthopaedic clinic as surgeon time was not required for this
  7. fDischarge is considered optimal as it is a definitive treatment
  8. MULTIPLE OUTCOMES:
  9. gMonitoring or OtherSpeciality in combination with other treatments (except discharge) were sub-optimal as they do not qualify as definitive treatment outcome
  10. hDischarge and OtherSpeciality which was optimal for all clinic types as a definitive treatment was given
  11. iImaging and/ or Injection were not routinely available to General Practitioner referrers so as non-surgical treatments they were considered optimal in advanced physiotherapy practitioner or specialist GP clinic. Imaging and/ or injection were considered optimal for orthopaedic clinic if combined with other non-surgical treatments such as physio or dietician
  12. kConsultant combined with multiple other outcomes were sub-optimal as there was no definitive outcome and introduce superfluous steps in the pathway
  13. lPhysio and Surgery or OtherSpeciality were optimal as there was a definitive treatment outcome
  14. mDietician and Discharge for all clinic types was sub-optimal outcome as there was specific local General Practitioner referral guidance around weight management
  15. nDischarge in combination with other treatments (except dietician) is optimal as it is a definitive treatment outcome