Health Bulletin

This document was published under a previous government.

Transforming MSK Care in Ontario

October 27, 2017

Ontarians with musculoskeletal (MSK) related conditions have some of the longest wait times for diagnostic imaging and surgical consultations, and many people waiting will not actually be helped by these services. The Ministry of Health's Access to Specialists and Specialty Care Strategy (ATS) aims to improve quality, access and appropriateness of care for patients; implementing MSK intake, assessment and management models is a key part of this work.

Some Local Health Integration Networks (LHINs) already have models of care in place that can be leveraged, such as hip and knee replacement Central Intake and Assessment Centres (CIACs). This model streamlines referral from primary care. An Advanced Practice Clinician (APC) will assess patients’ need for diagnostic imaging (e.g. MRI) or surgical consultation within a few weeks. Patients who require surgery are referred to the first available surgeon with the shortest wait list or a surgeon of their choice. Those who do not require surgery are linked to local community services for conservative management of their condition. 

Other models have also been tested that support appropriate local inter-professional care delivery for people with low back pain. The Inter-professional Spine Assessment and Education Clinic (ISAEC) model has shown success in avoiding unnecessary surgical consults and diagnostic imaging as well as shortening wait times for specialist care, where appropriate. An ISAEC evaluation demonstrated:

These models of care have proven to add value to patients, providers and the system by improving access, quality and resource utilization. By ensuring appropriateness of care we expect to direct resources to fund further surgical capacity.

Where are we now and what’s next?

The ministry and LHINs will scale and spread these models starting with the mandatory expansion of a hip and knee arthritis pathway(beginning with hip/knee replacement surgery in 2017/18) and the voluntary implementation of the low back management pathway (following the ISAEC model). Other evidence-based models will also be tested (e.g. shoulder pain) for integration into regional MSK intake, assessment and management programs. Linkages to local community services that provide conservative management will be made, such as the pre-existing Primary Care Low Back Pain pilots.

In addition to new operational funding for these models, the ministry will provide change management and project management supports to each LHIN through the Adopting Research to Improve Care (ARTIC) program which is co-led by the Council of Academic Hospitals of Ontario (CAHO) and Healthy Quality Ontario (HQO). A core team will provide “on the ground” advice and subject matter expertise to balance the implementation of a standardized model with local needs.

For further details on this work please contact Mansur Rahim, Senior Program Consultant, HQO Liaison and Program Development Branch, at

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