The overall aim of this project is to address gaping holes in how musculoskeletal pain is managed in BC primary care. We will plan and pilot the Musculoskeletal Comprehensive and Response in Emergency (MSK CARE) clinic in emergency departments and urgent care centres in the Fraser Health Authority. Similar clinics are running successfully in Perth, Australia, and in Eastern Canada (Montréal, Quebec City, Kingston, Calgary, Sherbrooke). In BC, there are not yet any clinics like MSK CARE, despite these types of clinics delivering shorter wait times, happier patients and expert care (Truter et al. 2024).
The project will tackle overcrowding in the emergency department and improve access to primary care in BC for all people with musculoskeletal pain, no matter where they live. We will measure whether the MSK CARE clinic can (1) reduce the amount of time people spend waiting in the emergency department, (2) improve the health and wellbeing of patients, and (3) reduce the cost of health care.
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PROJECT PLAN
Year 1 objective: Build an infrastructure to support the MSK CARE clinic
Subproject 1. Explore routinely-collected health administrative data
The intern will collate population-based data from Fraser Healths existing databases, to review and analyse the epidemiology (burden and diagnoses) of musculoskeletal conditions in emergency departments and urgent care centres across the Fraser Health Authority. Working with Fraser Health, the intern will identify key hospital metrics, patient demographics and other relevant health and social outcomes that are important to the Fraser Health community, to evaluate in year 2.
Subproject 2. Engage the Fraser Health community to co-develop a plan to manage organisational change
The intern will interview patients, clinicians, and administrative staff to identify barriers and facilitators to implementing a MSK CARE clinic. The interviews will also gather insights into how and why people seek musculoskeletal care at emergency departments and urgent care centres.
Subproject 3. Implement staff training in advanced musculoskeletal assessment and management
The intern will adapt teaching and learning materials from our Canadian and Australian collaborators to the Fraser Health context, and implement a training program for clinicians recruited to staff the MSK CARE clinic.
Subproject 4. Plan and conduct a pilot non-randomised intervention study of the MSK CARE clinic
The results of subprojects 1 and 2, will guide the choice of pilot site(s) for the MSK CARE clinic. The intern will lead the ethics approvals, work with Fraser Health to establish systems and processes to support the MSK CARE clinic, and collect and analyse data to evaluate the effectiveness of the service. The choice of primary and secondary outcomes will be guided by the results of subprojects 1 and 2 (i.e. meaningful to all knowledge users, including clinicians, patients, health administrators and researchers).
Year 2 Objective: Evaluate feasibility of the MSK CARE clinic with virtual follow-up
We will pilot the MSK CARE clinic. We will identify a control site, where patients receive usual emergency department care (i.e. no MSK CARE clinic), based on the findings from subproject 1. Outcomes from the pilot will include: acceptability, feasibility and effectiveness of the clinic, an economic evaluation, and patient outcomes.
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SKILLS AND COMPETENCIES
The intern will learn how to:
*Review, analyse, interpret and present population-based data to guide health administrators decision-making
*Work with health service administrators to plan, implement and evaluate a primary care service
*Support health service leaders to implement strategies for managing staffing and workload across a health service
*Conduct mixed-methods research in an applied health service setting
*Craft knowledge mobilisation outputs for different health authority knowledge user groups (including health service administrators/leaders, clinicians, patients and community members)
HOW THE PROJECT AND INTERNSHIP WILL SUPPORT THE HEALTH ORGANISATION
This project is embedded in the Fraser Health Authority, which is the largest of the 5 health authorities in British Columbia. The project and internship will help Fraser Health reduce emergency department wait times and the proportion of patients not seen in the emergency department, which are two key metrics identified by Fraser Health as markers of health service efficiency.
Through analysing routinely-collected administrative data, the project will first help Fraser Health quantify the extent of the burden of musculoskeletal problems on its emergency departments and urgent care centres. The information will guide decisions about which locations(s) are best suited to serve as a pilot site(s) for an MSK CARE clinic(s). Next, the intern will adapt and implement existing training resources from our collaborators in Perth, Australia, and Montreal, and lead training for Fraser Health staff to upskill in musculoskeletal pain diagnosis and management.
Training existing Fraser Health staff will boost workforce capacity in managing acute and chronic musculoskeletal pain conditions in a primary care setting. Data collected during the pilot study of the MSK CARE clinic will provide opportunities for Fraser Health staff to contribute to research, leveraging a learning health systems model.