Holland Bone and Joint Program
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What is an Advanced Practice Provider?

In 2006, Sunnybrook's Holland Bone and Joint Program developed an award-winning model of care to improve access and quality of care for patients with hip and knee arthritis, shoulder pathology and spine pain in direct response to their needs. These APPs are experienced, specially trained health professionals. Our current team of APPs includes advanced practice physiotherapists and an advanced practice occupational therapist.

Our interprofessional team approach

The team approach to patient care expands the role of specially trained health professionals with post professional Master's or PhD Degrees and promotes a strong collaboration with orthopaedic surgeons and other members of the outpatient care team. This model is a viable strategy for meeting the growing demand for hip and knee replacement surgery and shoulder assessment at a time when there is a shortage of orthopaedic surgeons. Surgeons now spend a majority of their time seeing new patients, in the operating room and addressing complex patient care needs.

Advanced Practice Physiotherapists

Central intake and assessment

Our Advanced Practice Provider (APP) role includes:

  • Centralized referral management
  • Comprehensive patient assessment, and
  • Patient education on community resources and treatment options
  • Student education and research

With our team approach, APPs triage and prioritize all referrals to the Holland Centre and are the first point of contact for patients referred with hip, knee, shoulder pain - a role that was traditionally fulfilled by an orthopaedic surgeon. The APPs refer patients on to a surgeon based on specific criteria that includes urgency. Patients with hip and knee arthritis are given a choice of accepting the first available appointment or waiting for a specific surgeon. Patients who don't need surgery receive education about other treatment options.

Postoperative routine follow-up

Routine patient follow-up appointments after discharge from the hospital are also now managed by the APPs in their own clinics. The APPs have the expertise to meet patients' needs for education on recovery and participation in activity after surgery.

Expansion to the LHIN and Beyond

In 2007, the Holland Centre's initiative was leveraged to fulfill the vision of the Toronto Central Local Health Integration Network's (LHIN) Joint Wellness and Disease Management Program in a key area of need. In 2018, we provided leadership to Ontario Health in the provincial roll-out of this model of care. The concepts of this model can serve as a template for other practice areas beyond hip and knee arthritis.


Patricia Dickson, MSc, BScOT, OT Reg (Ont)
Clinical Supervisor, Advanced Practice Provider Team
Advanced Practice Occupational Therapist
Phone: 416-967-8634
Email: patricia.dickson@sunnybrook.ca

Maria Rachevitz, Advanced Practice Physiotherapist
Professional Leader, Low Back Rapid Access Clinic
Email: maria.rachevitz@sunnybrook.ca