Search

Long wait times for scheduled surgical procedures have long been a concern in Canadian health systems. (1) Access to health services is determined by the demand for services, the supply [...], Background: Little is known about the existing structure and function of referral networks in the prevalent referral system for specialized surgical care in Canada, which is based on direct physician referral to specialists in a largely unmanaged referral marketplace. Our objective was to describe and analyze the referral networks of referring physicians and surgeons for common surgical procedures in Ontario, to better understand potential barriers to single-entry models. Methods: We analyzed referral networks for patients between referring physicians and surgeons for 9 common scheduled surgical procedures from 2016 to 2019 using administrative data sources in Ontario. We described the connectedness of referring physician-surgeon pairs using descriptive measures and graphical social network analysis. Results: The median number of surgeons connected to a referring physician for patients having a particular surgical procedure ranged from 1 (interquartile range [IQR] 1-3) for spine surgery to 3 (IQR 1-4) for knee arthroplasty and 3 (IQR 2-5) for noncancer uterine procedures. Referral network structure varied according to the procedure studied. Spine surgery was highly clustered with a small number of larger groups; gallbladder, inguinal hernia, and noncancer uterine surgery were highly distributed with many small groups within the referral network. Breast cancer surgery occurred in a largely distributed network, but with a skewed distribution reflecting a few small groups with large numbers of patients. Conclusion: Improving surgical wait times by coordinating surgical referrals will require approaches that address the structure of existing referral networks. Most physicians refer their patients to a very small number of surgeons, suggesting that referring physicians largely do not individualize referrals to multiple different surgeons based on specific patient characteristics. Contexte : On en conna t peu sur la structure et le fonctionnement actuels des r seaux d'aiguillage du pr sent syst me de r partition des demandes de consultations en soins chirurgicaux sp cialis s au Canada car ce syst me repose sur les demandes adress es directement aux sp cialistes par les m decins traitants dans un contexte non g r . Notre objectif tait de d crire et d'analyser les r seaux d'aiguillage entre m decins traitants et sp cialistes en chirurgie pour les interventions courantes en Ontario, afin de mieux comprendre les obstacles potentiels aux mod les acc s unique. M thodes : Nous avons analys les r seaux d'aiguillage des patients et patientes entre les m decins traitants et les sp cialistes en chirurgie pour des interventions courantes planifi es de 2016 2019 partir de banques de donn es administratives ontariennes. Nous avons d crit l'appariement m decin traitant-sp cialiste en chirurgie l'aide de mesures descriptives et d'une repr sentation graphique des r seaux d'aiguillage. R sultats : Le nombre m dian de chirurgiennes et chirurgiens appari s un m decin traitant pour un type de chirurgie en particulier allait de 1 ( ventail interquartile [ I] 1-3) pour la chirurgie de la colonne vert brale 3 ( I 1-4) pour l'arthroplastie du genou et 3 ( I 2-5) pour les probl mes ut rins non canc reux. La structure des r seaux d'aiguillage variait selon l'intervention tudi e. La chirurgie de la colonne vert brale pr sentait plus de grappes, comportant un petit nombre de groupes plus denses; les chirurgies de la v sicule biliaire, de la hernie inguinale et des probl mes ut rins non canc reux taient largement distribu es, comportant plusieurs groupes restreints travers tout le r seau d'aiguillage. La chirurgie pour cancer du sein tait largement r partie, mais sa distribution tait asym trique, t moignant d'un nombre restreint de petits groupes plus nombreux de patientes. Conclusion : Pour am liorer les temps d'attente en coordonnant les demandes de consultation en chirurgie, il faudra des approches ax es sur les r seaux d'aiguillage existants. La plupart des m decins traitants orientent leur patient le vers un tr s petit nombre de chirurgiennes et chirurgiens, ce qui laisse entendre que pour une bonne part, ils n'individualisent pas leurs demandes de consultation aupr s de multiples chirurgiennes ou chirurgiens en fonction des caract ristiques sp cifiques des malades.

Background: Canadian health systems fare poorly in providing timely access to elective surgical care, which is crucial for quality, trust, and satisfaction. Methods: We conducted a cross-sectional analysis of surgical wait times for adults receiving non-urgent cataract surgery, knee arthroplasty, hip arthroplasty, gallbladder surgery, and non-cancer uterine surgery in Ontario, Canada, between 2013 and 2019. We obtained data from the Wait Times Information System (WTIS) database. Inter- and intra-hospital and surgeon variations in wait time were described graphically with caterpillar plots. We used non-nested 3-level hierarchical random effects models to estimate variation partition coefficients, quantifying the proportion of wait time variance attributable to surgeons and hospitals. Results: A total of 942,605 procedures at 107 healthcare facilities, conducted by 1,834 surgeons, were included in the analysis. We observed significant intra- and inter-provider variations in wait times across all five surgical procedures. Inter-facility median wait time varied between six-fold for gallbladder surgery and 15-fold for knee arthroplasty. Inter-surgeon variation was more pronounced, ranging from a 17-fold median wait time difference for cataract surgery to a 216-fold difference for non-cancer uterine surgery. The proportion of variation in wait times attributable to facilities ranged from 6.2% for gallbladder surgery to 23.0% for cataract surgery. In comparison, surgeon-related variation ranged from 16.0% for non-cancer uterine surgery to 28.0% for cataract surgery. Implications: There is extreme variability in surgical wait times for five common, high-volume, non-urgent surgical procedures. Strategies to address surgical wait times must address the variation between service providers through better coordination of supply and demand. Approaches such as single-entry models could improve surgical system performance. [ABSTRACT FROM AUTHOR]