This study explores the outcomes of a pilot project involving five Orthopaedic services in developing approaches to improve the consistency and equity of clinical decision-making for access to treatment. The pilot was conducted in two phases; the first involved development of retrospective and prospective data collection and analysis tools including use of:
The Orthopaedic Integrated CPAC tool: Euroquol and Oxford Hip and Knee quality of life measures, A surgical decision construct tool to identify patterns in clinical judgement A clinician survey Phase two involved a locally managed feedback and improvement process. Large variations in internal equity were found within most services. Additionally a significant, systemic equity issue is apparent between patients prioritised for major joints versus other conditions. The pilot has made useful progress in developing improvement tools and processes targeting electives service management, improvements in prioritisation and clinical decision making, and funding and planning decisions. The pilot has also raised issues for further CPAC development and national service policy.
