Models of care for musculoskeletal health: A cross-sectional qualitative study of Australian stakeholders' perspectives on relevance and standardised evaluation

Background: The prevalence and impact of musculoskeletal conditions are predicted to rapidly escalate in the coming decades. Effective strategies are required to minimise 'evidence-practice', 'burden-policy' and 'burden-service' gaps and optimise health system responsiveness for sustainable, best-practice healthcare. One mechanism by which evidence can be translated into practice and policy is through Models of Care (MoCs), which provide a blueprint for health services planning and delivery. While evidence supports the effectiveness of musculoskeletal MoCs for improving health outcomes and system efficiencies, no standardised national approach to evaluation in terms of their 'readiness' for implementation and 'success' after implementation, is yet available. Further, the value assigned to MoCs by end users is uncertain. This qualitative study aimed to explore end users' views on the relevance of musculoskeletal MoCs to their work and value of a standardised evaluation approach. Methods: A cross-sectional qualitative study was undertaken. Subject matter experts (SMEs) with health, policy and administration and consumer backgrounds were drawn from three Australian states. A semi-structured interview schedule was developed and piloted to explore perceptions about musculoskeletal MoCs including: i) aspects important to their work (or life, for consumers) ii) usefulness of standardised evaluation frameworks to judge 'readiness' and 'success' and iii) challenges associated with standardised evaluation. Verbatim transcripts were analysed by two researchers using a grounded theory approach to derive key themes. Results: Twenty-seven SMEs (n = 19; 70.4 % female) including five (18.5 %) consumers participated in the study. MoCs were perceived as critical for influencing and initiating changes to best-practice healthcare planning and delivery and providing practical guidance on how to implement and evaluate services. A 'readiness' evaluation framework assessing whether critical components across the health system had been considered prior to implementation was strongly supported, while 'success' was perceived as an already familiar evaluation concept. Perceived challenges associated with standardised evaluation included identifying, defining and measuring key 'readiness' and 'success' indicators; impacts of systems and context changes; cost; meaningful stakeholder consultation and developing a widely applicable framework. Conclusions: A standardised evaluation framework that includes a strong focus on 'readiness' is important to ensure successful and sustainable implementation of musculoskeletal MoCs

Supporting evaluation and implementation of musculoskeletal Models of Care: A globally-informed framework for judging 'readiness' and 'success'.

Objective To develop a globally-informed framework to evaluate 'readiness' for implementation and 'success' after implementation of musculoskeletal Models of Care (MoCs). Methods Three-phases were undertaken: 1) qualitative study with 27 Australian subject matter experts (SMEs) to develop a draft Framework; 2) eDelphi study with an international panel of 93 SMEs across 30 nations to evaluate face validity, refine and establish consensus on the Framework components; and 3) translation of the Framework into a user-focused resource and evaluation of its acceptability with the eDelphi panel. Results A comprehensive evaluation framework was developed for judging 'readiness' and 'success' of musculoskeletal MoCs. The Framework consists of nine domains, with each domain containing a number of themes underpinned by detailed elements. In the first Delphi round, scores of 'partly agree' or 'completely agree' with the draft Framework ranged from 96.7-100%. In the second round, 'essential' scores ranged from 58.6-98.9%, resulting in 14 of 34 themes being classified as essential. SMEs strongly agreed or agreed that the final Framework was useful (98.8%), usable (95.1%), credible (100%) and appealing (93.9%). Overall, 96.3% strongly supported or supported the final structure of the Framework as it was presented, while 100%, 96.3% and 100% strongly supported or supported the content within the readiness, initiating implementation and success streams, respectively. Conclusions An empirically-derived framework to evaluate the readiness and success of musculoskeletal MoCs was strongly supported by an international panel of SMEs. The Framework provides an important internationally-applicable benchmark for the development, implementation and evaluation of musculoskeletal MoCs. This article is protected by copyright. All rights reserved