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Exploring the Business Case for Improving Quality of Care for Patients With Chronic Rotator Cuff Tears

Eubank, Breda H. PhD, CAT(C); Emery, J. C. Herbert PhD; Lafave, Mark R. PhD, CAT(C); Wiley, J. Preston MD, MPE, CCFP(SEM), FCFP; Sheps, David M. MD, MSc, MBA, FRCSC; Mohtadi, Nicholas G. MD, MSc, FRCSC

doi: 10.1097/QMH.0000000000000231
Original Research
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Background and Objectives: Currently, management of patients presenting with chronic rotator cuff tears in Alberta is in need of quality improvements. This article explores the potential impact of a proposed care pathway whereby all patients presenting with chronic rotator cuff tears in Alberta would adopt an early, conservative management plan as the first stage of care; ultrasound investigation would be the preferred tool for diagnosing a rotator cuff tear; and only patients are referred for surgery once conservative measures have been exhausted.

Methods: We evaluate evidence in support of surgery and conservative management, compare care in the current state with the proposed care pathway, and identify potential solutions in moving toward optimal care.

Results: A literature search resulted in an absence of indications for either surgical or conservative management. Conservative management has the potential to reduce utilization of public health care resources and may be preferable to surgery. The proposed care pathway has the potential to avoid nearly Can $87 000 in public health care costs in the current system for every 100 patients treated successfully with conservative management.

Conclusion: The proposed care pathway is a low-cost, first-stage treatment that is cost-effective and has the potential to reduce unnecessary, costly surgical procedures.

Department of Health and Physical Education, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Alberta Canada (Drs Eubank and Lafave); Department of Economics, University of New Brunswick, Fredericton, Canada (Dr Emery); Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada (Drs Wiley and Mohtadi); and Division of Orthopaedics, Department of Surgery, University of Alberta, Edmonton, Canada (Dr Sheps).

Correspondence: Breda H. Eubank, PhD, CAT(C), Department of Health and Physical Education, Faculty of Health, Community, and Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6 (beubank@mtroyal.ca).

The authors declare no conflicts of interest.

© 2019Wolters Kluwer Health | Lippincott Williams & Wilkins