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Quality Improvement

Improving care for people with musculoskeletal conditions


One in three adults live with musculoskeletal (MSK) conditions -- health conditions that affect muscles, bones or joints, and cause pain and mobility issues.

Patients can often wait months for an MRI or an appointment to see a surgical specialist, even when these may not be the best options for them.

Evidence also shows that prolonged wait times for musculoskeletal treatment is a major contributor to opioid use disorder.

This page is your source for evidence-based tools and resources to support the implementation of Rapid Access Clinics.


Rapid Access Clinics: Providing the right treatment, faster

To help people with musculoskeletal conditions, including hip, knee and low-back pain access the right treatment faster, Rapid Access Clinics across the province are expanding.

Read more about the Rapid Access Clinic initiative here.


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Rapid Access Clinics- Information and tools


Recently released wait-time data shows that patients with musculoskeletal conditions spend the most time waiting to access health-care services, like MRI even though they may not be the best options for them.

Ontario is expanding Rapid Access Clinics across the province to help people with hip, knee and low-back pain access the right treatment faster.

Patients will receive appropriate care sooner, reducing unnecessary wait times and making the best use of existing resources.


How does it work?

  • Patients will be referred by a primary-care provider to a Rapid Access Clinic, where they will receive a timely assessment from an Advanced Practice Provider, (usually a physiotherapist or chiropractor).

  • If a patient needs surgery, they will be offered the next available appointment or have the option to choose an appointment with their preferred surgeon.

  • If a patient does not need surgery, they will be given a self-management plan co-developed by the patient and the Advanced Practice Provider, and monitored by the patient’s primary-care provider. The patient may also be connected with additional health-care supports in their community.

  • Key leaders in musculoskeletal care were consulted to inform the implementation of standardized components of this initiative. These leaders represent various disciplines, such as rheumatology, rehabilitation care, orthopaedic surgery, primary care, family medicine and diagnostic imaging, and include patient representatives.

  • Your Local Health Integration Network (LHIN) is working to implement this proven approach to musculoskeletal care.


Pilot program success

Central Intake and Assessment Centres and the Inter-professional Spine Assessment and Education Clinic pilots have shown that the Rapid Access Clinic model benefits both patients and health-care providers.

  • Central Intake and Assessment Centres – These Centres have streamlined care for patients with hip or knee arthritis, and improved surgeons’ wait-list management, referral practices and communication with family physicians.

  • Inter-professional Spine Assessment and Education Clinics (ISAEC) program – This program specializes in the management and treatment of low-back pain. It is an innovative, upstream, shared-care model designed to decrease the prevalence of unmanageable, chronic low-back pain and reduce the initiation of opioids.

    The program streamlines care by reducing unnecessary surgical consultations and diagnostic imaging, and shortens wait times for appointments with specialists.

    Program pilot results show that patients have a perceived improvement in their symptoms, better understanding of their musculoskeletal conditions and high satisfaction with their clinic consultation and experience.

For more information on this initiative, email ARTIC@hqontario.ca.

Rapid Access Clinics benefit patients, primary-care providers and surgeons


Patients will:

  • Receive an assessment and management strategy from the clinic within four weeks.

  • Benefit from improved care coordination. There will be quicker and more seamless communication between their Advanced Practice Provider and their surgeon, if required. And all assessment findings and management strategies will be shared with their primary-care provider.

  • Be provided with education about their condition.

  • Be provided with self-management support tools, if appropriate.

  • Have the option of seeing the next available surgeon near their address or the surgeon of their choice, if consultation with a surgeon is recommended.


Primary care providers will:

  • Receive training and education in musculoskeletal assessment and management.

  • Have one point of contact for all patient referrals and will follow defined referral criteria. This simplified, streamlined intake process will ensure patients receive appropriate care sooner.

  • Experience improved coordination of care for their patients, including additional resources for patient support and education, and facilitated surgical consultations, when needed.


Surgeons will:

  • Receive more appropriate referrals, allowing for more predictable practice management.

Centralized intake

Requests for consultation will be processed through one central point of contact in each LHIN.

Primary-care providers will use defined referral criteria and standardized referral forms so they know who to refer and when, and what information is needed.


Central intake is intended to:

  • Provide a single point of contact to refer patients for specialist care.

  • Streamline the intake process so patients receive more timely assessments, (up to four weeks for an assessment with an Advanced Practice Provider) and consultation with surgeon specialists.

  • Triage referrals based on standardized criteria.

  • Route referrals to the appropriate assessment location based on the patient’s address or preference.

  • Manage local wait-time data: each LHIN will have current wait times for each surgeon and will be able to offer patients their choice of next available surgery times or preferred surgeon or hospital.

  • Provide surgical patients with their choice of hospital, surgeon or the first available surgeon with the shortest wait time.

  • Improve surgeons’ wait-list management and referral practices.

  • Improve communication with referral sources, (e.g. general practitioners and specialists).

For more information, contact the musculoskeletal Rapid Access Clinic central intake in your LHIN.

Assessment and management of hip and knee arthritis:

  • The Advanced Practice Provider will complete a comprehensive patient history and physical examination, functional assessment and diagnostic imaging based on standardized criteria. Evidence shows that the Advanced Practice Provider assessments are comparable to those of surgeons in terms of diagnostic accuracy, treatment effectiveness and patient satisfaction.

  • Patients will receive individualized recommendations and a plan for their care. Results of the assessment and the recommendations will be provided to the primary-care provider. Re-assessments by the Advanced Practice Providers are available so that patients and their primary-care providers have ongoing support.

  • Surgeons will receive more appropriate referrals, which will allow for more predictable practice management and time spent with surgical patients.


An evaluation of this model of care currently in seven of Ontario’s 14 LHINs shows that:

  • Overall, patients and care providers are highly satisfied. Patients report satisfaction with the timely access to a comprehensive consultation, the subsequent management strategies for their conditions, and the education that prepares them for discussions with their surgeons.

  • Surgeons have found value in the role of the Advanced Practice Provider and have confidence in their assessments, which allows them to spend less time assessing patients who are not surgical candidates.

  • The seven LHINs that have implemented this collaborative model of care have seen an improvement in their wait times for hip and knee replacement surgery.

If you are a health-care provider, please visit your LHIN’s website for information on how to refer patients with hip and knee arthritis.


Additional resources for arthritis care:

  1. Osteoarthritis quality standard addresses care for adults 18 years of age or older who are diagnosed with or suspected of having osteoarthritis of the knee, hip or hand. It includes all settings and care providers.

  2. Quality-Based Procedures: Clinical Handbook for Primary Hip and Knee Replacement

  3. Arthritis Alliance of Canada, Centre for Effective Practice and the College of Family Physicians of Canada: Osteoarthritis Tool for primary care providers who are managing patients with new or recurrent joint pain consistent with osteoarthritis in the hip and knee.

  4. Bone and Joint Canada—Osteoarthritis.

Assessment and Management of Low-Back Pain

Inter-professional Spine Assessment and Education Clinics (ISAEC) program – patients in this program receive rapid low-back pain assessment, education and evidence-based self-management plans.


This model of care:

  • Has been piloted in Toronto, Hamilton and Thunder Bay since 2012.

  • Has since been successful in decreasing MRI use within the ISAEC network by more than 30%.

  • Significantly reduces the risk of chronic pain.

  • Has maintained extremely high patient (99%) and primary-care provider (97%) satisfaction rates.

The ISAEC program is now expanding across Ontario as part of the Rapid Access Clinics.

For more information on ISAEC, please visit www.isaec.org.

As the Rapid Access Clinic model of care matures in each region, additional proven treatments for managing other prevalent musculoskeletal conditions will be included in this program.

Two ways ARTIC is supporting musculoskeletal care in Ontario:

  1. Working with the Ministry of Health and Long Term Care to support the implementation of the Rapid Access Clinic initiative for musculoskeletal conditions across Ontario.

  2. Working with clinical leads across the province, regional Project Implementation Teams and LHINs to support this initiative using the proven ARTIC model.

Learn more about other ARTIC-supported initiatives here.

ARTIC (Adopting Research to Improve Care) is a joint program of Health Quality Ontario and the Council of Academic Hospitals of Ontario that is accelerating the spread of proven care across the province.

For more information on how this successful program is spreading, email ARTIC@hqontario.ca.

Community of Practice

Access the Rapid Access Clinic community. Learn, share and innovate with others who are implementing Rapid Access Clinics in Ontario.


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QUALITY STANDARDS

Quality Standards outline for clinicians and patients what quality care looks like based on the best available evidence. New Quality Standards for osteoarthritis and low-back pain are coming soon.

Quality Standards for opioid prescribing for acute pain and opioid prescribing for chronic pain are available now.

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Wait Times for Surgeries and Procedures

Wait times are an important measure of how quickly care can be accessed. Learn about wait times for hip and knee replacement, and MRIs.

Learn more
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Adopting Research to Improve Care (ARTIC) Program

The Adopting Research to Improve Care (ARTIC) Program accelerates the spread of proven care.

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Our Partners

Health Quality Ontario would like to thank all of our partners who generously shared their expertise in musculoskeletal care.

The Local Health Integration Network logo The Ministry of Health and Long-term Care logo Council of Academic Hospitals of Ontario logo

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