Close

We are using cookies to give you the best experience on our site. Cookies are files stored in your browser and are used by most websites to help personalise your web experience.

By continuing to use our website without changing the settings, you are agreeing to our use of cookies.

Find out more
You are here:
> MSK Recommended Indicator Set

MSK Recommended
Indicator Set

A standard set of indicators for musculoskeletal health services relevant to people with arthritis and commissioners, created in partnership with the musculoskeletal community

What is the MSK Recommended Indicator Set?

The indicators below describe the value, quality and cost of musculoskeletal services, aimed at those who are responsible for shaping services (commissioners and providers) and also relevant and meaningful to clinicians and patients.

Musculoskeletal system

Indicator 1: Percent of total CCG annual spend which is on services for musculoskeletal (MSK) conditions

Rationale

It's a measure of CCG spend on MSK services as share of total CCG spend, compared to spend in earlier years and compared to the CCG spend on other clinical areas. It can also be used to compare with size of MSK spend in other CCGs.

Availability

Spend data are produced for the programme budgeting spend tool (formerly these data were available as part of the spend and outcome tool item 15, spend on problems of the MSK system).

Caveats

It might be difficult to obtain the specified programme budgeting spend data as required for the above definition.

Indicator 2: Ratio of musculoskeletal (MSK)-related consultants (trauma and orthopaedics, spinal surgeons, rheumatology, pain medicine) to MSK-specialist allied health professionals

Rationale

Indication of the balance between various members of the clinical MSK teams.

Availability

Data will need to be collected from organisations’ human resources departments and the number of consultant and allied health professional staff serving each CCG estimated using the percent of patients in the catchment area of each organisation which are from each CCG.

Caveats

Obtaining these data and the analyses might not be straightforward.

Indicator 3: Spend on pain medications (excluding paracetamol, weak opiates)

Rationale

Allows analysis of variations in prescribing and in use of resources.

Availability

Data should be available from medication spending data, but this needs testing.

Caveats

The implications of various patterns of spend require investigation.

Indicator 4: Percent of people with a long-term musculoskeletal (MSK)-related problem who state they have a written, personalised, specified, care plan which is reviewed regularly within a specified period

Rationale

High-quality primary care services should work with people with an MSK condition to develop an agreed, defined care plan which is reviewed (at least) annually.

Availability

Good – from GP Patient Survey (GPPS) Q59, all parts. Denominator – use from GPPS people reporting arthritis or back pain.

Caveats

The proportion of people with an MSK condition who respond that they have a care plan is about 12% and there might be problems with low prevalence and low variation in the numbers of patients who respond. Further, the existence of a care plan doesn't in itself demonstrate high-quality care planning.

Indicator 5: Time from referral (GP, self or other) to first allied health professional review for musculoskeletal (MSK) patients

Rationale

Indicator of the quality of MSK primary and specialist services and their co-ordination. Measure of quality and efficiency of interface between primary and specialist MSK care.

Availability

Should be available from the Community Information Data Set.

Caveats

Availability needs checking and usefulness in practice needs testing in a pilot.

Musculoskeletal health promotion

Indicator 6: Percent of patients with osteoarthritis or with rheumatoid arthritis who have a body mass index (BMI) of 30 and above (obese)

Rationale

Indicates the need for obesity reduction interventions for secondary prevention of musculoskeletal conditions.

Availability

Not yet routinely produced.

Caveats

The data for this indicator will require extraction of data items from GP registers.

Indicator 7: Percent of adults with osteoarthritis who receive advice on participating in muscle strengthening and aerobic exercise

Rationale

An indicator of care quality: good care of osteoarthritis patients includes appropriate exercise advice.

Availability

Not currently routinely available.

Caveats

Data for the numerator will probably require new data collection from provider records. Denominator data will require special data collection from GP records.

Osteoarthritis

Indicator 8: Rate of elective primary hip replacement per expected prevalence of severe hip osteoarthritis

Availability

Good – numerator data are available from Hospital Episode Statistics and denominator data from the Arthritis Research UK MSK Calculator.

Caveats

High or low rates by themselves don't necessarily indicate low or high rates of patient clinical severity thresholds of listing for surgery.

Indicator 9: Rate of elective primary knee replacement per expected prevalence of severe knee osteoarthritis

Rationale

Allows analysis of variation in healthcare use of resources. Large variation, especially very high or low rates, indicates need for investigation. Based on knee replacement rate per head of estimated population with knee arthritis from the Arthritis Research UK MSK Calculator.

Availability

Good – numerator data are available from Hospital Episode Statistics and denominator data from the Arthritis Research UK MSK Calculator.

Caveats

High or low rates by themselves don't necessarily indicate low or high rates of patient clinical severity thresholds of listing for surgery.

Indicator 10: Mean length of stay for elective hip and knee replacement patients

Rationale

Indicator of implementation of enhanced recovery for surgery procedures. Allows analysis of variation in use of resources.

Availability

Good, from Hospital Episode Statistics.

Caveats

None.

Indicator 11: Percent of patients who have non-elective readmission to hospital within 28 days of either elective primary hip or knee replacement

Rationale

Indicator of surgical quality: after adjusting for age, sex and co-morbidities (using case mix analysis) from Hospital Episode Statistics diagnosis coding, higher readmission rate after 28 days indicates lower quality.

Availability

Good.

Caveats

None bar the need to test for variable procedure and diagnostic coding of hospital data from each hospital.

Indicator 12: Rate of knee arthroscopy in patients aged over 60 years

Rationale

High knee arthroscopy rates in patients aged 60+ may be perceived as an indicator of less than optimal treatment and thus a poor use of resources.

Availability

Good, from Hospital Episode Statistics.

Caveats

The usefulness of this formulation of the indicator in assessing poor use of resources needs to be tested in a pilot.

Back pain

Indicator 13: A&E attendances secondary to back pain per population prevalence of back pain

Rationale

The number of hospital A&E attendances per period is a possible indicator of quality of community services for back pain; comparatively high rates indicate the need for investigation.

Availability

From Hospital Episode Statistics A&E data set.

Caveats

In practice, diagnosis fields might not be recorded sufficiently and uniformly well across England to be of practical use. Therefore the use of this indicator requires piloting. Alternatives include "the number of unplanned hospital admissions with a primary or secondary recorded diagnosis of back pain".

Indicator 14: Rate of facet joint injections

Rationale

Variation from the mean, especially comparatively high rates, warrants investigation: use of facet joint injections as a treatment (not diagnostic procedure), isn't supported by the evidence base.

Availability

Good, numerator is from Hospital Episode Statistics.

Caveats

Some facet joint injections are diagnostic, and are appropriate; piloting is required to determine whether the indicator needs to be revised to take this into account.

Rheumatoid arthritis

Indicator 15: Percent of patients with suspected rheumatoid arthritis seen in a rheumatology service for confirmation of diagnosis within three weeks of referral

Rationale

If a patient presents with suspected rheumatoid arthritis then they should be assessed in a rheumatology service for confirmation of diagnosis within three weeks after the onset of symptoms (NICE QS33) to improve health outcomes.

Availability

From the British Society for Rheumatology/Healthcare Quality Improvement Partnership audit.

Caveats

The audit is relatively new and data may be incomplete.

Indicator 16: Spend on biological therapies/drugs per expected prevalence of rheumatoid arthritis

Rationale

Allows analysis of variations in prescribing and in use of resources; variations in biologic need may reflect standards of care.

Availability

Precise data on biologic drug spend for rheumatoid arthritis aren't routinely available, but within programme budgets there's a "high-cost drug" line in musculoskeletal programme budget which may be a reasonable proxy.

Caveats

The implications of various patterns of spend require investigation.

Fragility fractures

Indicator 17: Prevalence rate of hip fracture

Availability

Good.

Caveats

None.

Indicator 18: Percent of hospital inpatient admissions for hip fracture which qualify for fragility hip fracture conditional best practice tariff payments

Rationale

Taken together the components of the fragility hip fracture conditional best practice tariff indicate co-ordinated, appropriate, timely fragility fracture, and possibly all orthopaedic, inpatient care.

Availability

Good.

Caveats

None.

Indicator 19: Percent of patients with hip fracture, admitted to hospital from own home, returning home within 30 days

Rationale

This indicator helps inform the degree of effectiveness of treatment for a hip fracture, including rehabilitation support after discharge.

Availability

Good.

Caveats

The completeness and quality of the National Hip Fracture Database (NHFD) data items will need to be tested.

Musculoskeletal health outcomes

Indicator 20: Change in health utility score from baseline to six-months post treatment

Rationale

Indicator of level of health-related quality of life change related to clinical MSK care.

Availability

Will require special data collection.

Caveats

The usefulness of this indicator requires testing. Outcomes of piloting of Musculoskeletal Health Questionnaire (MSK-HQ) aren't yet available. Need to further understand most useful timing for collection.

Indicator 21: Percent of people of working age locally who are receiving Employment Support Allowance (ESA) due to a musculoskeletal (MSK) problem

Rationale

Important indicator of service outcome – the proportion of working age people whose haven't had their musculoskeletal health needs sufficiently met for them to remain at, or return to, work.

Availability

Numerator: the Department for Work and Pensions has data on numbers of people on ESA by medical condition. Denominator: from modelled prevalence data for osteoarthritis, rheumatoid arthritis and back pain.

Caveats

Numerator data: the practicality of obtaining the ESA data at local level broken down by musculoskeletal conditions will need to be tested; ESA numbers are based on what is recorded at the point of claim and not as an output of the assessment. Denominator data: these will depend on the availability of modelled prevalence estimates for the specific musculoskeletal conditions. Use of this indicator for comparison purposes may be best done between local areas with similar unemployment/deprivation rates and should be tested.

Indicator 22: Rheumatic conditions care patient service experience scores

Rationale

An important aspect of the quality of musculoskeletal (MSK) services can be indicated by the quality of patient experience as recorded by individual patients.

Availability

Not routinely collected.

Caveats

Data collection at the patient level isn't easy and takes patient and staff time. These data haven't been collected routinely and will have to be tested in a pilot to determine how far patients’ responses accurately represent their actual experiences.

Related information

Public health bulletins

Data and statistics on the prevalence of osteoarthritis and back pain in different regions of England.

A woman talking with her GP

MSK-HQ

The MSK-HQ is a short questionnaire that allows people with musculoskeletal conditions to report their symptoms and quality of life in a standardised way.

graph

MSK Calculator

The first tool to give estimates of how common musculoskeletal conditions are across England.

For more information, go to www.arthritisresearchuk.org.
Arthritis Research UK fund research into the cause, treatment and cure of arthritis. You can support Arthritis Research UK by volunteering, donating or visiting our shops.