Capacity-Building for Musculoskeletal Care in Palau – the Role of Physiatry

Thursday, October 23, 2025

12:45 PM - 2:15 PM MT

Location: Kiosk 8

Poster Presenter(s)

Eli M. Snyder, Other

Medical Student
University of Hawaii at Manoa, John A. Burns School of Medicine
Honolulu, Hawaii

Co-Author(s)

KW

Kelley Withy, MD, PhD

Professor, AHEC Director
University of Hawaii Medical School
Honolulu, Hawaii
GD

Gregory J. Dever, MD, MD

Retired Clinical Pediatrician; Director, Palau Area Health Education Center
John A, Burns School of Medicine
Koror, Koror, Palau
CD

Catherine Decherong, Other

Palau Area Health Education Center, Deputy Director
Palau Area Health Education Center
Honolulu, Hawaii
DR

David Rovinsky, MD (he/him/his)

Assistant Clinical Professor
University of Hawaii, John A. Burns School of Medicine
Kapaa, Hawaii
CA

Cedric K. Akau, MD, MPH

Physiatrist, Hawaii Pacific Medical Group and Clinical Professor, John A. Burns School of Medicine
Straub Benioff Medical Center
Honolulu, Hawaii
RK

Robin Kamal, MBA, MD, Other

Associate Professor
Stanford University
Redwood City, California
LS

Lauren Shapiro, MD

Assistant Professor
UCSF
San Francisco, California

Disclosure(s):

Eli M. Snyder, Other: No financial relationships to disclose

David Rovinsky, MD: No relevant disclosure to display

Cedric K. Akau, MD, MPH: No financial relationships to disclose

Background and/or Objectives: Palau is a medically underserved island nation in Micronesia with limited access to specialized musculoskeletal care. There are no physiatrists on-island, and access to orthopaedic surgeons is sporadic. This epidemiologic and financial analysis assessed the incidence of musculoskeletal conditions and quantified referral spending to guide future interventions to build capacity for musculoskeletal care and enhance care quality, access, and value in Palau.

Design: Data was collected from Palau’s national hospital’s electronic health record (EHR) and from the Palau Medical Referral Committee reports. Results were reported descriptively.

Setting : Secondary care hospital.

Participants : There were 1,235 patients in the EHR with musculoskeletal diagnoses between November 2022 and July 2023, totaling 1,762 encounters. There were 53 patients referred off-island for musculoskeletal care between October 2018 and June 2023.

Interventions: Not applicable.

Main Outcome Measures: Incidence of musculoskeletal conditions and off-island referral costs.

Results: EHR data showed the most common anatomic regions affected were the back/spine, knee/lower leg, and foot/ankle. The most common diagnoses were pain (47%), osteoarthritis (15%), sprain/tear (11%), and fracture (10%). Off-island referral expenditures totaled $1,546,068.50, with the most money spent on fractures ($510,247.20), spinal stenosis ($96,574.25), and osteoarthritis ($90,058.42).

Conclusions: Quality of care may be improved for the greatest number of patients in Palau through capacity-building efforts targeting pain, osteoarthritis, and sprain/tear management. Osteoarthritis management initiatives may also decrease referral spending. Physiatrists may utilize a task-shifting approach in which they offer further training related to musculoskeletal disease prevention, management, and rehabilitation, enabling primary care physicians, nurses, physical therapists, and other providers to practice at the top of their licenses. In-person and online training outreach may improve accessibility and quality of musculoskeletal care in Palau with an emphasis on functional outcomes.