title: Triage of spine surgery referrals through a multidisciplinary care pathway: a value-based comparison with conventional referral processes.
abstract: METHODS
  Retrospective medical record review.
  
  
  OBJECTIVE
  To (1) determine if outpatient referrals for low back pain (LBP) and leg pain triaged through a multidisciplinary spine care pathway (group A) were more likely to be candidates for surgery than conventional physician referrals (group B); (2) compare relevant clinical differences in the 2 groups (e.g., diagnosis, pain scores, level of disability); and (3) compare wait times for magnetic resonance imaging and surgical assessment.
  
  
  BACKGROUND
  The Saskatchewan Spine Pathway was introduced on the basis of evidence that a co-ordinated, multidisciplinary, and stratified approach to the assessment and management of LBP may improve quality. During early implementation, some physicians began to refer patients to Saskatchewan Spine Pathway clinics, whereas others continued to refer patients directly to the surgeon through the conventional process.
  
  
  METHODS
  We retrospectively analyzed consecutive new outpatient referrals for LBP and leg pain, June 1, 2011 through May 30, 2012 for 2 surgeons.
  
  
  RESULTS
  We identified 215 referrals, including 66 (30.7%) in group A and 149 (69.3%) in group B. There was no difference in overall health (mean EuroQol Group 5-Dimension Self-Report Questionnaire visual analogue scale) or lower back-related disability score (Oswestry Disability Index). Group A patients were significantly more likely to be candidates for surgery (59.1% vs. 37.6% for group B; P = 0.0034, χ test), had significantly poorer scores for EuroQol Group 5-Dimension Self-Report Questionnaire mobility, a higher proportion of leg dominant pain, and a lower proportion of back dominant pain. Group A patients also had significantly shorter wait times for magnetic resonance imaging and surgical assessment.
  
  
  CONCLUSIONS
  A co-ordinated multidisciplinary pathway with a stratified approach to LBP assessment and care provided a greater proportion of surgery candidates than the conventional referral process. 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.
  
  
  METHODS
  3.
authors.affiliation: From the Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
authors.forename: Chelsea S
authors.initials: CS
authors.lastname: Wilgenbusch
authors.forename: Adam S
authors.initials: AS
authors.lastname: Wu
authors.forename: Daryl R
authors.initials: DR
authors.lastname: Fourney
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D019091:Critical Pathways; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007866:Leg; D017116:Low Back Pain / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010348:Patient Care Team; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012525:Saskatchewan; D013122:Spinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014218:Triage / Q000706:statistics & numerical data*