A group of spine surgeon researchers examined whether triaging spine surgery referrals through a multidisciplinary care pathway created more value than the conventional referral process and published their findings in Spine.
The study examined outpatient referrals for low back pain and leg pain triggered through the multidisciplinary spine care pathway. They compared whether these patients were more likely candidates for surgery than those who were referred through the conventional physician referral process. They also compared clinical differences between the groups and wait times for MRI and surgical assessment.
The Saskatchewan Spine Pathway is the evidence-based pathway introduced to coordinate multidisciplinary spine care. The data on consecutive new outpatient referrals for low back pain and leg pain were examined from June 1, 2011 to May 30, 2012 for two surgeons.
There were 215 referrals in the Saskatchewan Spine Pathway and 149 referrals from the conventional physician referral pathway. The researchers found:
1. No difference in overall health; the average EuroQol Group 5-Dimension Self-Report Questionnaire visual analogue scale was similar between the groups.
2. Both groups had similar Oswestry Disability Index scores measuring lower back related disability.
3. The patients who went through the Saskatchewan Spine Pathway were significantly more likely to be surgical candidates. There were 59 percent of the patients in that pathway who were surgical candidates, compared to 37.6 percent among the conventionally-referred patients.
4. The patients who were referred through the Saskatchewan Spine Pathway also had significantly poorer EuroQol Group 5-Dimension Self-Report Questionnaire mobility. This group also reported:
• Higher proportion of leg dominant pain
• Lower proportion of back dominant pain
5. There were significantly shorter MRI and surgical assessment wait times for patients in the Saskatchewan Spine Pathway group. "The implementation of such processes may allow surgeons to restrict their practices to patients who are more likely to benefit from their services, thereby reducing wait times and potentially reducing costs," the study authors concluded.