Physiotherapy Department, ABMU HB, Morriston Hospital, Swansea, SA6 6NL, UK.
Medical Directors Department, ABMU HB, Port Talbot, UK.
Musculoskelet Sci Pract. 2019 Feb;39:67-72. doi: 10.1016/j.msksp.2018.11.002. Epub 2018 Nov 15.
Achilles tendinopathy is a common pathology that is considered difficult to treat. At a time of austerity in the NHS it is essential to have carefully designed pathways that are monitored in terms of cost and effectiveness. However, a paucity of evidence exists for what the "best value" dedicated "joined up" pathway of care is for this difficult condition.
Design, implement and evaluate the impact of a new therapist lead pathway for Tendon- Achilles Pain (TAP). METHODS: Process mapping, driver diagrams, stakeholder analysis and a series of Plan-Do-Study-Act cycles were used to design and implement TAP. To assess the impact of TAP, data was compared on whole system measures for 46 patients treated with referral to the traditional service (without TAP) and 46 patients managed according to the newly designed pathway (with TAP). A cost analysis was also conducted.
A quality improvement approach led to the successful design and implementation of a therapist lead TAP. The impact of TAP included positive effects on patient satisfaction, a decrease in duplication of treatments, investigations and inappropriate reviews with consultants. No safety concerns were found. TAP was also £44,000 cheaper per annum than the previous service.
Collaboration between orthopaedic and therapy services has resulted in a standardised pathway of care for patients with an Achilles tendinopathy. It has removed unwanted variation, provided an opportunity to monitor the outcomes of treatments and resulted in decreased cost for the health board.
跟腱病是一种常见的、难以治疗的疾病。在国民保健制度（NHS）面临紧缩的情况下，我们必须精心设计治疗路径，并对其成本和效果进行监控。然而，目前针对这种棘手疾病，哪种“最具价值”的“连贯”治疗路径效果最佳，相关证据却非常有限。
设计、实施并评估新型治疗师主导的跟腱疼痛（TAP）治疗路径的效果。
采用流程映射、驱动图、利益相关者分析和一系列计划-执行-研究-行动（PDCA）循环，设计并实施 TAP。为了评估 TAP 的效果，我们比较了接受传统服务（无 TAP）和新设计路径（有 TAP）治疗的 46 名患者的全系统治疗数据。我们还进行了成本分析。
采用质量改进方法成功设计并实施了治疗师主导的 TAP。TAP 的实施效果包括提高了患者满意度，减少了治疗、检查和不必要的顾问会诊的重复，没有发现安全问题。TAP 每年还为医疗保健委员会节省了 44,000 英镑的费用。
骨科和治疗服务之间的合作，为跟腱病患者制定了标准化的治疗路径。该路径消除了不必要的差异，提供了监测治疗效果的机会，并降低了医疗保健委员会的成本。
