Wilgenbusch Chelsea S, Wu Adam S, Fourney Daryl R
From the Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
Spine (Phila Pa 1976). 2014 Oct 15;39(22 Suppl 1):S129-35. doi: 10.1097/BRS.0000000000000574.
Retrospective medical record review.
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.
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.
We retrospectively analyzed consecutive new outpatient referrals for LBP and leg pain, June 1, 2011 through May 30, 2012 for 2 surgeons.
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.
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.
回顾性病历审查。
（1）确定通过多学科脊柱护理路径进行分流的腰痛（LBP）和腿痛门诊转诊患者（A组）比传统医生转诊患者（B组）更有可能成为手术候选者；（2）比较两组的相关临床差异（如诊断、疼痛评分、残疾程度）；（3）比较磁共振成像和手术评估的等待时间。
萨斯喀彻温省脊柱路径是在有证据表明采用协调、多学科和分层的方法来评估和管理腰痛可能会提高质量的基础上引入的。在早期实施过程中，一些医生开始将患者转诊至萨斯喀彻温省脊柱路径诊所，而另一些医生则继续通过传统流程将患者直接转诊给外科医生。
我们回顾性分析了2011年6月1日至2012年5月30日期间两位外科医生连续收到的腰痛和腿痛新门诊转诊病例。
我们共识别出215例转诊病例，其中A组66例（30.7%），B组149例（69.3%）。两组患者的总体健康状况（欧洲五维健康量表视觉模拟评分）或下背部相关残疾评分（Oswestry残疾指数）无差异。A组患者成为手术候选者的可能性显著更高（A组为59.1%，B组为37.6%；P = 0.0034，χ检验），欧洲五维健康量表活动能力评分显著更低，腿部为主疼痛的比例更高，背部为主疼痛的比例更低。A组患者进行磁共振成像和手术评估的等待时间也显著更短。
与传统转诊流程相比，采用分层方法进行腰痛评估和护理的协调多学科路径产生了更大比例的手术候选者。实施此类流程可能使外科医生将业务范围限制于更有可能从其服务中受益的患者，从而减少等待时间并可能降低成本。
3级。
