REDESIGNING SERVICE DELIVERY FOR PEOPLE WITH BACK PAIN IN AN AUSTRALIAN HOSPITAL SETTING: A LOGIC MODEL FOR CHANGE

E. Gorgon^1,2,3, K. Maka⁴, A. Kam⁴, J. Young⁴, J. Sullivan¹, G. Nisbet¹, M. Hancock¹, A. Leaver¹

¹The University of Sydney, Faculty of Medicine and Health, Sydney, Australia, ²Neuroscience Research Australia, Spinal Cord Injury Research Centre, Sydney, Australia, ³University of the Philippines Manila, Department of Physical Therapy, Manila, Philippines, ⁴New South Wales Health, Western Sydney Local Health District, Sydney, Australia

Background: Back pain remains the leading cause of disability in the world and traditional models of care focusing on treating anatomical and biomechanical impairments have been largely unsuccessful in mitigating the disability burden. New models of organising and delivering care are needed to increase uptake of best practice care. Models of care may succeed or fail depending on the context of implementation and therefore context is crucial. A Logic Model of the Health Problem was created as the first step in an intervention mapping approach toward developing and testing a new service for people with back pain in a large teaching hospital in a culturally and linguistically diverse community in Sydney, Australia.

Purpose: This paper outlines the development of a Logic Model for Change to improve service delivery for people with chronic back pain, based on the Logic Model of the Health Problem and stakeholder input.

Methods: Intervention mapping provided the overarching framework for service development. A core clinical-academic leadership group drafted service delivery outcomes and objectives and determined key components of a new service, drawing on information from the Logic Model of the Health Problem and stakeholder input through a participatory approach. Important determinants that needed to be changed to meet the service delivery outcomes and objectives were also identified. Each key component was organised as a statement of the service delivery solution (i.e., a Logic Model for Change) which explained how a new service would change the determinants, achieve the outcomes and objectives, and consequently improve patients’ health and quality of life. The Logic Models for Change were updated based on feedback from multidisciplinary stakeholders across hospital outpatient services involved in back pain care.

Results: Four key components of a new service were identified, with the themes around: 1) patient education with an emphasis on addressing pathoanatomical focus and setting management expectations; 2) unified patient triage and multidisciplinary approach to assessment; 3) a case management and consultancy role for hospital clinicians; and d) health and lifestyle projects for patients that address secondary prevention. Overall, there was stakeholder consensus (at least 80% agreement) on the conceptualisation of the service delivery solutions as depicted in the Logic Models for Change. However, qualitative feedback suggested some stakeholder concerns particularly around a proposed shift to a case management and consultancy role and the feasibility of implementing centralised triage and assessment.

Conclusions: Good overall stakeholder agreement highlights material acceptance of the approach to service redesign and this can facilitate the next steps which involve producing relevant resources and planning a detailed protocol for a new service. Strategies need to be implemented to allay stakeholder concerns, otherwise it would be difficult to secure the stakeholder acceptance necessary to complete the service development process.

Implications: The key components of a new service require input from external stakeholders (i.e., patients and referrers) to increase relevance and acceptability. Following completion of the service design phase, the design of a new service can be translated into a comprehensive and detailed protocol that can be tested in a cohort study or clinical trial.

Keywords:
Health service delivery
Evidence-based practice
Musculoskeletal health

Topics:
Research methodology, knowledge translation & implementation science
Musculoskeletal: spine
Service delivery/emerging roles

Did this work require ethics approval? Yes

Institution: Western Sydney Local Health District

Committee: Human Research Ethics Committee

Ethics number: QA 1811-18, QA 1903-05, 2019/ETH09876, 2020/ETH02078