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Abstract
Objectives We assessed: (1) waiting time variation among surgeons; (2) proportion of patients receiving surgery within benchmark and (3) influence of the Winnipeg Central Intake Service (WCIS) across five dimensions of quality: accessibility, acceptability, appropriateness, effectiveness, safety.
Design Preimplementation/postimplementation cross-sectional design comparing historical (n=2282) and prospective (n=2397) cohorts.
Setting Regional, provincial health authority.
Participants Patients awaiting total joint replacement of the hip or knee.
Interventions The WCIS is a single-entry model (SEM) to improve access to total hip replacement (THR) or total knee replacement (TKR) surgery, implemented to minimise variation in total waiting time (TW) across orthopaedic surgeons and increase the proportion of surgeries within 26 weeks (benchmark). Impact of SEMs on quality of care is poorly understood.
Primary and secondary outcome measures Primary outcomes related to ‘accessibility’: waiting time variation across surgeons, waiting times (Waiting Time 2 (WT2)=decision to treat until surgery and TW=total waiting time) and surgeries within benchmark. Analysis included descriptive statistics, group comparisons and clustered regression.
Results Variability in TW among surgeons was reduced by 3.7 (hip) and 4.3 (knee) weeks. Mean waiting was reduced for TKR (WT2/TW); TKR within benchmark increased by 5.9%. Accessibility and safety were the only quality dimensions that changed (post-WCIS THR and TKR). Shorter WT2 was associated with post-WCIS (knee), worse Oxford score (hip and knee) and having medical comorbidities (hip). Meeting benchmark was associated with post-WCIS (knee), lower Body Mass Index (BMI) (hip) and worse Oxford score (hip and knee).
Conclusions The WCIS reduced variability across surgeon waiting times, with modest reductions in overall waits for surgery. There was improvement in some, but not all, dimensions of quality.
- health policy
- health services administration and management
- organisation of health services
- quality in healthcare
- adult surgery
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Footnotes
Contributors ZD initiated the collaborative project, conceptualised and designed the study, analysed and interpreted the data, drafted and revised and finalised the paper. EB initiated the collaborative project and provided methodological advice, conceptualised and designed the study, monitored data collection and revised the draft paper. HQ and TN provided methodological advice, supported analysis and revised the draft paper. GM contributed to the interpretation of the data and revised the draft paper. LL provided methodological advice, analysed and interpreted the data, and revised the draft paper. DAM initiated the collaborative project, conceptualised and designed the study, interpreted the data, drafted and revised and finalised the paper. All authors read and approved the final manuscript being submitted.
Funding This research was supported by a Canadian Institutes for Health Research (CIHR) Evidence-Informed Healthcare Renewal Initiative Grant (#289181) and a CIHR Emerging Team Grant (#92252). ZD is supported by an Alberta Innovates—Health Solutions MD/PhD Studentship (#201100210). DAM is supported by a Canada Research Chair in Health Services and Systems Research (2008-2018) and the Arthur J.E. Child Chair Rheumatology Outcomes Research. Publication of our findings is supported by the Arthur J.E. Child Chair in Rheumatology Outcomes Research.
Competing interests EB is the Medical Director of the Winnipeg Central Intake Service and Chair of the Winnipeg Regional Health Authority Orthopaedic Standards and Quality committee. DAM consults on an ad hoc basis as an advisor for health outcomes and health economics research through Optum Insights and RTI Health Solutions and directly for various pharmaceutical companies on specific research projects and advisory boards. This content was prepared for a poster presentation by ZD at the 2017 Canadian Association for Health Services and Policy Research (CAHSPR) Conference; Toronto, ON: 25 May 2017: ZD, EB, HQ, TN, GM, LL, DAM. Improving quality of care for scheduled clinical services: results from a post-policy implementation review of the Winnipeg Central Intake Service, a single-entry model of referral for total joint replacement.
Patient consent for publication Not required.
Ethics approval This study received approval from the University of Calgary Conjoint Health Research Ethics Board (REB13-0119) and Research Ethics Board of the University of Manitoba (H2012:198).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement This study was funded by a grant from the Canadian Institutes of Health Research (CIHR; Evidence-Informed Healthcare Renewal Initiative Grant (#289181)). CIHR requires grant recipients to retain original data sets arising from CIHR-funded research for a minimum of five years after the end of the grant. This applies to all data, whether published or not. Therefore, data will not be shared.