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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 outcomes

Optimal/ suboptimal outcome combinations

Specialist GP clinic

Advanced physiotherapy practitioner clinic

Orthopaedic clinic

Single outcomes

 Consultanta

Sub-optimala

sub-optimala

sub-optimala

 Physiob

optimalb

optimalb

sub-optimalb

 Dieticianb

optimalb

optimalb

sub-optimalb

 Monitoringc

sub-optimalc

sub-optimalc

sub-optimalc

 Surgeryd

sub-optimald

sub-optimald

optimal

 Imaginge

optimale

optimale

sub-optimale

 Injectione

optimale

optimale

sub-optimale

 Dischargedf

optimalf

optimalf

optimalf

Multiple outcomes

 Consultant & imagingk

sub-optimalk

sub-optimalk

sub-optimalk

 Consultant & injectionk

sub-optimalk

sub-optimalk

sub-optimalk

 Consultant & physiok

sub-optimalk

sub-optimalk

sub-optimalk

 Dietician & dischargedm

sub-optimalm

sub-optimalm

sub-optimalm

 Dietician & Imagingi

optimali

optimali

optimali

 Dietician & injectioni

optimali

optimali

optimali

 Dietician & injection & dischargedi

optimali

optimali

optimali

 Dietician & monitoringg

sub-optimalg

sub-optimalg

sub-optimalg

 Discharged & other specialityh

optimalh

optimalh

optimalh

 Imaging & dischargedn

optimaln

optimaln

optimaln

 Imaging & injectioni

optimali

optimali

optimali

 Imaging & other specialityg

sub-optimalg

sub-optimalg

sub-optimalg

 Injection & dischargedn

optimaln

optimaln

optimaln

 Injection & other specialityg

sub-optimalg

sub-optimalg

sub-optimalg

 Monitoring & imagingg

sub-optimalg

sub-optimalg

sub-optimalg

 Monitoring & imaging & injectiong

sub-optimalg

sub-optimalg

sub-optimalg

 Monitoring & injectiong

sub-optimalg

sub-optimalg

sub-optimalg

 Monitoring & other specialityg

sub-optimalg

sub-optimalg

sub-optimalg

 Physio & dietician & dischargedn

optimaln

optimaln

optimaln

 Physio & dietician & injectioni

optimali

optimali

optimali

 Physio & dietician & monitoringg

sub-optimalg

sub-optimalg

sub-optimalg

 Physio & dischargedn

optimaln

optimaln

optimaln

 Physio & imagingi

optimali

optimali

optimali

 Physio & imaging & injectioni

optimali

optimali

optimali

 Physio & injectioni

optimali

optimali

optimali

Physio & monitoringg

sub-optimalg

sub-optimalg

sub-optimalg

 Physio & monitoring & imagingg

sub-optimalg

sub-optimalg

sub-optimalg

 Physio & monitoring & injectiong

sub-optimalg

sub-optimalg

sub-optimalg

 Physio & monitoring & otherspecialityg

sub-optimalg

sub-optimalg

sub-optimalg

 Physio & otherspecialityl

optimall

optimall

optimall

 Physio & surgeryl

optimall

optimall

optimall

Surgery & imagingl

optimall

optimall

optimall

  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
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BMC Musculoskeletal Disorders

ISSN: 1471-2474

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