REDESIGNING MUSCULOSKELETAL REFERRAL PATHWAYS IN EUROPE: SYSTEM-LEVEL EFFECTS OF A DIGITAL-SEROLOGY TRIAGE MODEL
Author(s)
Christian Suharlim, MPH, MD1, Raul Castellanos, MD, PhD1, Linda Mathsson-Alm, PhD1, Rachel Knevel, MD PhD2;
1Thermo Fisher Scientific, Waltham, MA, USA, 2Leiden University Medical Center, Leiden, Netherlands
1Thermo Fisher Scientific, Waltham, MA, USA, 2Leiden University Medical Center, Leiden, Netherlands
OBJECTIVES: Musculoskeletal conditions are a major driver of primary care demand in Europe, yet over 70% of referrals to rheumatology services are unnecessary, contributing to diagnostic delays and constrained specialist access. This study evaluated the system-level effects of an integrated digital-serology triage pathway (IDSTP) designed to shift musculoskeletal assessment earlier in the care pathway and improve referral accuracy across diverse European health systems.
METHODS: A decision-analytic model simulated diagnostic trajectories for adults presenting to primary care with musculoskeletal symptoms. Country-specific inputs from the Netherlands, Spain, Sweden, United Kingdom, and Hungary were derived from the EU-funded SPIDeRR programme, reflecting observed referral behavior, diagnostic delays, and specialist capacity constraints. IDSTP combined structured symptom assessment, algorithm-guided decision support, and targeted serologic testing, and was compared with usual care. Model outputs included referral appropriateness, mean diagnostic delay, avoidable consultations, and system-level pathway efficiency. Sensitivity analyses varied diagnostic performance, gatekeeping strength, and specialist availability to assess robustness across heterogeneous contexts.
RESULTS: Across five countries, IDSTP reduced overall referral rates by approximately 25 percent in the conservative base case. Improvements in diagnostic delay ranged from 1-2 months in systems with strong triage to 5-10 months in systems with weaker filtering. From a systems perspective, because specialist capacity remains below demand, total specialist consultations within the time horizon did not decline, though the share of appropriate referrals increased. From a patient perspective, IDSTP reduced avoidable consultations and wait times, improving care pathway efficiency. Scenario analyses indicated that system gains were greatest in settings with limited baseline gatekeeping.
CONCLUSIONS: A digital-serology triage pathway for musculoskeletal symptoms can improve referral accuracy, shorten diagnostic pathways, and support more efficient use of specialist capacity across European health systems. By shifting assessment upstream, the approach aligns with policy objectives focused on access, value, and system resilience. Prospective implementation and real-world evaluation are needed to confirm impact.
METHODS: A decision-analytic model simulated diagnostic trajectories for adults presenting to primary care with musculoskeletal symptoms. Country-specific inputs from the Netherlands, Spain, Sweden, United Kingdom, and Hungary were derived from the EU-funded SPIDeRR programme, reflecting observed referral behavior, diagnostic delays, and specialist capacity constraints. IDSTP combined structured symptom assessment, algorithm-guided decision support, and targeted serologic testing, and was compared with usual care. Model outputs included referral appropriateness, mean diagnostic delay, avoidable consultations, and system-level pathway efficiency. Sensitivity analyses varied diagnostic performance, gatekeeping strength, and specialist availability to assess robustness across heterogeneous contexts.
RESULTS: Across five countries, IDSTP reduced overall referral rates by approximately 25 percent in the conservative base case. Improvements in diagnostic delay ranged from 1-2 months in systems with strong triage to 5-10 months in systems with weaker filtering. From a systems perspective, because specialist capacity remains below demand, total specialist consultations within the time horizon did not decline, though the share of appropriate referrals increased. From a patient perspective, IDSTP reduced avoidable consultations and wait times, improving care pathway efficiency. Scenario analyses indicated that system gains were greatest in settings with limited baseline gatekeeping.
CONCLUSIONS: A digital-serology triage pathway for musculoskeletal symptoms can improve referral accuracy, shorten diagnostic pathways, and support more efficient use of specialist capacity across European health systems. By shifting assessment upstream, the approach aligns with policy objectives focused on access, value, and system resilience. Prospective implementation and real-world evaluation are needed to confirm impact.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD21
Topic
Health Service Delivery & Process of Care
Disease
SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)