MSK Recommended Indicator Set for healthcare professionals

This is a measure of CCG spend on MSK services as share of total CCG spend, compared to spend in earlier years and compared to the CCG spend on other clinical areas. It can also be used to compare with size of MSK spend in other CCGs.

Spend data are produced for the programme budgeting spend tool (formerly these data were available as part of the spend and outcome tool item 15, spend on problems of the MSK system).

It might be difficult to obtain the specified programme budgeting spend data as required for the above definition.

Indication of the balance between various members of the clinical MSK teams.

Data will need to be collected from organisations’ human resources departments and the number of consultant and allied health professional staff serving each CCG estimated using the percent of patients in the catchment area of each organisation which are from each CCG.

Obtaining these data and the analyses might not be straightforward.

Allows analysis of variations in prescribing and in use of resources.

Data should be available from medication spending data, but this needs testing.

The implications of various patterns of spend require investigation

High-quality primary care services should work with people with an MSK condition to develop an agreed, defined care plan which is reviewed (at least) annually.

Good – Numerator from GP Patient Survey (GPPS) Q59, all parts. Denominator – number of people in GPPS reporting arthritis or back pain.

The proportion of people with an MSK condition who respond that they have a care plan is about 12% and there might be problems with low prevalence and low variation in the numbers of patients who respond. Further, the existence of a care plan doesn't in itself demonstrate high-quality care planning.

Indicator of the quality of MSK primary and specialist services and their co-ordination. Measure of quality and efficiency of interface between primary and specialist MSK care.

Should be available from the Community Information Data Set (CIDS). However CIDS is due to be retired and replaced by the Community Services Data Set (CSDS).

Availability needs checking and usefulness in practice needs testing in a pilot.

Indicates the need for obesity reduction interventions for secondary prevention of musculoskeletal conditions.

Not yet routinely produced.

The data for this indicator will require extraction of data items from GP registers.

An indicator of care quality: good care of osteoarthritis patients includes appropriate exercise advice.

Not currently routinely available.

Data for the numerator will probably require new data collection from provider records. Denominator data will require special data collection from GP records.

Allows analysis of variation in healthcare use of resources. Large variation, especially very high or low rates, indicates need for investigation. Based on hip replacement rate per head of estimated population with severe hip osteoarthritis.

Good – numerator data are available from Hospital Episode Statistics and denominator data from the Arthritis Research UK MSK Calculator.

High or low rates by themselves don't necessarily indicate low or high rates of patient clinical severity thresholds of listing for surgery.

Allows analysis of variation in healthcare use of resources. Large variation, especially very high or low rates, indicates need for investigation. Based on knee replacement rate per head of estimated population with knee arthritis from the Arthritis Research UK MSK Calculator.

Good – numerator data are available from Hospital Episode Statistics and denominator data from the Arthritis Research UK MSK Calculator.

High or low rates by themselves don't necessarily indicate low or high rates of patient clinical severity thresholds of listing for surgery.

Indicator of implementation of enhanced recovery for surgery procedures. Allows analysis of variation in use of resources.

Good, from Hospital Episode Statistics.

None.

Indicator of surgical quality: after adjusting for age, sex and co-morbidities (using case mix analysis) from Hospital Episode Statistics diagnosis coding, higher readmission rate after 28 days indicates lower quality.

Good, from Hospital Episode Statistics.

None bar the need to test for variable procedure and diagnostic coding of hospital data from each hospital.

High knee arthroscopy rates in patients aged 60+ years may be perceived as an indicator of less than optimal treatment and thus a poor use of resources.

Good, from Hospital Episode Statistics.

The usefulness of this formulation of the indicator in assessing poor use of resources needs to be tested in a pilot.

The number of hospital A&E attendances per period is a possible indicator of quality of community services for back pain; comparatively high rates indicate the need for investigation.

From Hospital Episode Statistics A&E data set.

In practice, diagnosis fields might not be recorded sufficiently and uniformly well across England to be of practical use. Therefore the use of this indicator requires piloting. Alternatives include "the number of unplanned hospital admissions with a primary or secondary recorded diagnosis of back pain".

Variation from the mean, especially comparatively high rates, warrants investigation: use of facet joint injections as a treatment (not diagnostic procedure), isn't supported by the evidence base.

Good, numerator is from Hospital Episode Statistics.

Some facet joint injections are diagnostic, and are appropriate; piloting is required to determine whether the indicator needs to be revised to take this into account.

If a patient presents with suspected rheumatoid arthritis then they should be assessed in a rheumatology service for confirmation of diagnosis within three weeks after the onset of symptoms (NICE QS33) to improve health outcomes.

From the British Society for Rheumatology/Healthcare Quality Improvement Partnership audit: National clinical audit for rheumatoid and early inflammatory arthritis.

The audit ran from 2014 to 2015, and is due to restart in 2017.

Allows analysis of variations in prescribing and in use of resources; variations in biologic need may reflect standards of care.

Precise data on biologic drug spend for rheumatoid arthritis aren't routinely available, but within programme budgets there's a "high-cost drug" line in musculoskeletal programme budget which may be a reasonable proxy.

The implications of various patterns of spend require investigation.

Indicator of the need for primary and secondary prevention of osteoporosis, falls prevention.

Good.

None.

Taken together the components of the fragility hip fracture conditional best practice tariff indicate co-ordinated, appropriate, timely fragility fracture inpatient care.

Good.

None.

This indicator helps inform the degree of effectiveness of treatment for a hip fracture, including rehabilitation support after discharge.

Good.

The completeness and quality of the National Hip Fracture Database (NHFD) data items will need to be tested.

Indicator of level of health-related quality of life change related to clinical MSK care.

Will require special data collection.

The usefulness of this indicator requires testing. Outcomes of piloting the Musculoskeletal Health Questionnaire (MSK-HQ) are now available and have shown to be more sensitive than the EQ-5D. However, there is a need to further understand how it can be used.

Important indicator of service outcome – the proportion of working age people whose haven't had their musculoskeletal health needs sufficiently met for them to remain at, or return to, work.

Numerator: the Department for Work and Pensions has data on numbers of people on ESA by medical condition. Denominator: from modelled prevalence data for osteoarthritis, rheumatoid arthritis and back pain.

Numerator data: the practicality of obtaining the ESA data at local level broken down by musculoskeletal conditions will need to be tested; ESA numbers are based on what is recorded at the point of claim and not as an output of the assessment. Denominator data: these will depend on the availability of modelled prevalence estimates for the specific musculoskeletal conditions. Use of this indicator for comparison purposes may be best done between local areas with similar unemployment/deprivation rates and should be tested.

An important aspect of the quality of musculoskeletal (MSK) services can be indicated by the quality of patient experience as recorded by individual patients.

Not routinely collected.

Data collection at the patient level isn't easy and takes patient and staff time. These data haven't been collected routinely and will have to be tested in a pilot to determine how far patients’ responses accurately represent their actual experiences.