Quality-Based Procedures: Clinical Handbook for ...

1 Quality-Based procedures : Clinical Handbook for degenerative disorders of the Shoulder Health Quality Ontario & Ministry of Health and Long-Term Care July 2015. Quality-Based procedures : Clinical Handbook for degenerative disorders of the Shoulder. July 2015; pp. 1 86 1. Suggested Citation This report should be cited as follows: Health Quality Ontario and Ministry of Health and Long-Term Care. Quality-Based procedures : Clinical Handbook for degenerative disorders of the shoulder. Toronto (ON): Health Quality Ontario; 2015 TBD. 86 p. Available from: TBD. Permission Requests All inquiries regarding permission to reproduce any content in Health Quality Ontario reports should be directed to How to Obtain Clinical Handbooks from Health Quality Ontario All Clinical handbooks are freely available in PDF format at the following URL: and-ohtac-recommendations/ Clinical -handb ooks.

2 Conflict of Interest Statement There are no competing interests or conflicts of interest to declare. About Health Quality Ontario Health Quality Ontario is the provincial advisor on the quality of health care in Ontario, evaluating the effectiveness of health care technologies and services, providing evidence-based recommendations, reporting to the public on the quality of the health system, and supporting the spread of quality improvement throughout the system. Disclaimer The content in this document has been developed through collaborative efforts between the Ministry of Health and Long-Term Care, Health Quality Ontario, and the Expert Advisory Panel on degenerative disorders of the Shoulder.

3 The template for the Quality-Based procedures Clinical Handbook and all content in the Purpose and Introduction sections were provided in standard form by the ministry. All other content was developed by Health Quality Ontario with input from the expert advisory panel. As it is based in part on rapid reviews and expert opinion, this Handbook may not reflect all the available scientific research and is not intended as an exhaustive analysis. Health Quality Ontario assumes no responsibility for omissions or incomplete analysis resulting from its reports. In addition, it is possible that other relevant scientific findings may have been reported since completion of the Handbook and/or rapid reviews.

4 This report is current to the date of the literature search specified in the Research Methods section of each rapid review. This Handbook may be superseded by an updated publication on the same topic. A list of all Health Quality Ontario Quality-Based procedures Clinical Handbooks is available at Quality-Based procedures : Clinical Handbook for degenerative disorders of the Shoulder. July 2015; pp. 1 86 2. Table of Contents List of Abbreviations .. 5. Purpose .. 6. 7. Money Follows the Patient' .. 8. What Are Quality-Based procedures ? .. 8. Practice Variation .. 9. Availability of Evidence .. 9. Feasibility/Infrastructure for Change .. 10. Cost Impact .. 10. Impact on Transformation .. 10.

5 How Will QBPs Encourage the Delivery of High-Quality, Evidence-Based Care and Innovation in Health Care Delivery? .. 11. Methods .. 12. Overview of Episode-of-Care Analysis Approach .. 12. Defining the Approach to Cohort and Patient 13. Developing the Episode-of-Care Pathway Model .. 13. Identifying Recommended Practices .. 13. Consideration of Evidence Sources .. 13. Ontario Health Technology Advisory Committee Recommendations .. 14. Clinical Guidelines .. 14. Evidence 15. Analysis of Administrative and Clinical Data .. 15. Expert 15. Description of degenerative disorders of the Shoulder .. 16. Glenohumeral Osteoarthritis .. 16. Rotator Cuff 16. degenerative disorders of the Shoulder: Cohort and Case Mix Analysis.

6 18. Cohort Inclusion and Exclusion Criteria .. 18. Inclusion Criteria .. 18. Exclusion Criteria .. 19. Shoulder QBP 21. Current State Utilization 22. Episode-of-Care Model .. 25. Recommended Practices for degenerative disorders of the Shoulder .. 26. Sources Used to Develop Recommended Practices .. 26. Health Quality Ontario Evidence Reviews and Ontario Health Technology Advisory Committee Recommendations .. 26. Health Quality Ontario Rapid 26. Clinical Guidelines .. 27. Language Used to Reference Relevant Guidelines and Evidence Sources .. 30. Episode-of-Care Recommended 30. Module 1: Assessment, Nonsurgical Management, and Referral .. 31. Quality-Based procedures : Clinical Handbook for degenerative disorders of the Shoulder.

7 July 2015; pp. 1 86 3. Module 2: Coordinated Intake and Assessment Process .. 34. Module 3: Decision Regarding Surgical Treatment Clinical Assessment Node .. 36. Module 4: Pre-operative Screening .. 38. Module 5: Pre-operative 41. Module 6: 42. Module 7: Recovery and After-Care .. 45. Module 8: Post-acute Care .. 47. Module 9: Follow-Up .. 49. Implementation of Best Practices .. 50. System-Wide 50. Establish Regional Coordinated Intake and Assessment Processes .. 50. Continue to Shift Non-arthroplasty Shoulder procedures From In-patient to Outpatient Settings When Safe to Do So .. 51. Develop and Deploy Integrated Funding Models for Shoulder Care .. 51. Regional-Level Considerations .. 52.

8 Provision of Administrative Data .. 52. Measuring the Gap .. 52. Capacity Planning .. 52. Service Capacity Planning .. 52. Implementation of Recommended Practices .. 53. Provider-Level Implementation .. 53. Performance Evaluation and Feedback .. 56. Method of Selection of Indicators for degenerative disorders of the Shoulder .. 56. Results .. 57. Support for Change .. 63. Expert Advisory Panel 64. References .. 66. Appendices .. 70. Appendix 1: Indicator Technical 70. Part 1. Key Performance Indicators .. 70. Part 2. Recommendation-Specific Indicators .. 82. Appendix 2: Rapid Reviews .. 87. Quality-Based procedures : Clinical Handbook for degenerative disorders of the Shoulder. July 2015; pp.

9 1 86 4. List of Abbreviations AGREE Appraisal of Guidelines for Research and Evaluation DAD Discharge Abstract Database GRADE Grading of Recommendations Assessment, Development and Evaluation HSFR Health System Funding Reform LHIN Local Health Integration Network MRI Magnetic resonance imaging NACRS National Ambulatory Care Reporting System QBP Quality-Based Procedure Quality-Based procedures : Clinical Handbook for degenerative disorders of the Shoulder. July 2015; pp. 1 86 5. Quality-Based procedures Clinical Handbook for degenerative disorders of the Shoulder Purpose This Clinical Handbook has been created to serve as a compendium of the evidence-based rationale and Clinical consensus driving the development of the policy framework and implementation approach for degenerative disorders of the shoulder.

10 This document has been prepared for informational purposes only. This document does not mandate health care providers to provide services in accordance with the recommendations included herein. The recommendations included in this document are not intended to take the place of the professional skill and judgment of health care providers. Quality-Based procedures : Clinical Handbook for degenerative disorders of the Shoulder. July 2015; pp. 1 86 6. Introduction The Ministry of Health and Long-Term Care (ministry) established Health System Funding Reform (HSFR). in Ontario in 2012 with a goal to develop and implement a strategic funding system that promotes the delivery of quality health care services across the continuum of care, and is driven by evidence and efficiency.