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Gryczynski J, Mitchell SG, Whitter M, Fuller D, Mitchell MM, Edelman EJ, Schwartz RP. A trial of implementation facilitation to increase timely admission to methadone treatment. J Subst Use Addict Treat 2024; 162:209375. [PMID: 38642889 DOI: 10.1016/j.josat.2024.209375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/27/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND During the ongoing opioid epidemic, some Opioid Treatment Programs (OTPs) are unable to admit program applicants in a timely fashion. Interim methadone (IM) treatment (without routine counseling) is an effective approach to overcome this challenge when counseling capacity is inadequate to permit admissions within 14 days of request. It requires both federal and state approval and has been rarely utilized since its incorporation into the federal OTP regulations in 1993. METHODS We evaluated the impact of Implementation Facilitation (IF) on OTPs providing timely admission to methadone treatment (i.e., within 14 days of request), adopting IM, and changing admissions procedures. IF included data collection on admission processes and an external facilitator who engaged OTP leadership, Local Champions through site visits, remote academic detailing, and feedback. Local Champions and State Opioid Treatment Authorities (SOTAs) participated in learning collaboratives. Using a modified stepped wedge design, six OTPs in four US states on the east and west coasts were randomly assigned to one of two clusters that staggered the timing of IF receipt. Study Phases included: Pre-Implementation, IF, and Sustainability. OTPs submitted data on treatment requests and admissions for 28 months (N = 3108 requests for treatment). RESULTS Although none of the OTPs adopted IM, all six developed policies and procedures to enable its use. Some OTPs streamlined admissions processes prior to study launch and during the IF intervention. OTPs reduced admission delays over time, although there was substantial site heterogeneity. The IF Phase for the early cluster coincided with the onset of COVID-19, complicating the study. Rates of timely admission within 14 days of request were 56.2 % (Pre-Implementation), 55.8 % (IF), and 78.8 % (Sustainability). Compared to the Pre-Implementation Phase, the odds of timely admission were not significantly different during the IF Phase but significantly higher during the Sustainability Phase (OR = 2.35 [95 % CI = 1.34, 4.12]; p = 0.003). CONCLUSIONS Committing to study participation and IF activities may have prompted some OTPs to change practices that improved timely admission. Attributing changes to IF should be done with caution considering study limitations. Data collection for the study spanned the COVID-19 pandemic, which complicates interpretation. TRIAL REGISTRATION Clinicaltrials.gov registration # NCT04188977.
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Affiliation(s)
- J Gryczynski
- Friends Research Institute, Inc., Baltimore, MD, United States of America.
| | - S G Mitchell
- Friends Research Institute, Inc., Baltimore, MD, United States of America
| | - M Whitter
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., United States of America
| | - D Fuller
- National Association of State Alcohol and Drug Abuse Directors, Inc., Washington, D.C., United States of America
| | - M M Mitchell
- MMM was with FRI at time of the study, United States of America
| | - E J Edelman
- Yale Schools of Medicine and Public Health, New Haven, CT, United States of America
| | - R P Schwartz
- Friends Research Institute, Inc., Baltimore, MD, United States of America
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Pazin-Filho A, do Valle Dallora MEL, Velasco TR, Cardoso Dos Santos RDO, Volpe GJ, Moroço DM, de Souza DA, Canabrava CM, Garcia LV, Joviliano EE, Maciel BC. Surgical waiting lists and queue management in a Brazilian tertiary public hospital. BMC Health Serv Res 2024; 24:290. [PMID: 38448876 PMCID: PMC10916210 DOI: 10.1186/s12913-024-10735-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/15/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System (BUHS). We describe the implementation of the "Patients with Surgical Indication" (PSI) in a Brazilian public tertiary hospital, the impact on waiting time, and its use in rationing oncological surgeries during the COVID-19 Pandemic. METHODS Retrospective observational study of elective surgical requests (2016-2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. RESULTS We enrolled 82,844 indications in the PSI (2016-2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p < 0.01). The same occurred with the backlog that ranged from 6,884 in 2016 to 844 in 2022 (p < 001). During the Pandemic, there was a reduction in the number of non-oncological surgeries per month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I (January 2019-March 2020), maintenance in Phase II (April 2020-August 2021) 0.1(-10.0;10.4) and increment in Phase III (September 2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions, these numbers were 0.6(-2.1;3.3) for Phase I, an increase of 3.2(0.7;5.6) in Phase II and 3.9(1,4;6,4) in Phase III. CONCLUSION Implementing a centralized list of surgical indications and developing queue management principles proved feasible, with effective rationing. It unprecedentedly demonstrated the decrease in the median waiting time in Brazil.
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Affiliation(s)
- Antonio Pazin-Filho
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
| | | | - Tonicarlo Rodrigues Velasco
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Gustavo Jardim Volpe
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Diego Marques Moroço
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Danilo Arruda de Souza
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Luis Vicente Garcia
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Benedito Carlos Maciel
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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Jabbal M, Burt J, Clarke J, Moran M, Walmsley P, Jenkins PJ. Trends in incidence and average waiting time for arthroplasty from 1998-2021: an observational study of 282,367 patients from the Scottish arthroplasty project. Ann R Coll Surg Engl 2024; 106:249-255. [PMID: 37365920 PMCID: PMC10911452 DOI: 10.1308/rcsann.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Current waiting times for arthroplasty are reported as being the worst on record. This is a combination of increasing demand, the COVID-19 pandemic and longer standing shortage of capacity. The Scottish Arthroplasty Project (SAP) is a National Audit that analyses all joint replacements undertaken in the Scottish NHS and Independent Sector. The aim of this study was to investigate the long-term trend in provision and waiting time for lower limb joint replacement surgery. METHODS All total hip replacements (THR) and total knee replacements (TKR) undertaken in NHS Scotland from 1998 to 2021 were identified. Waiting times data were analysed each year to determine the minimum, maximum, median, mean and standard deviation. RESULTS In 1998, there were 4,224 THR and 2,898 TKR with mean (range, SD) waiting time of 159.5 days (1-1,685, 119.8) and 182.9 days (1-1,946, 130.1). The minimum waiting times were both in 2013 for 7,612 THR - 78.8 days (0-539, 46) and 7,146 TKR - 79.1 days (0-489, 43.7). The maximum waiting times recorded were in 2021 with 4,070 THR waiting 283.7 days (0-945, 215) and 3,153 TKR waiting 316.8 days (4-1,064, 217). CONCLUSIONS This is the first robust large-scale national dataset showing trends in incidence and waiting time for THR and TKR over two decades. There was an expansion of activity with a reduction in waiting time, which peaked in 2013, followed by an increase in waiting time with a plateau and modest decline in the number of procedures.
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Affiliation(s)
- M Jabbal
- Royal Infirmary of Edinburgh, UK
| | - J Burt
- Golden Jubilee National Hospital, UK
| | - J Clarke
- Golden Jubilee National Hospital, UK
| | - M Moran
- Royal Infirmary of Edinburgh, UK
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Jatobá A, Bellas H, Arcuri R, Sobral ALA, Bulhões B, Vianna J, de Castro Nunes P, d'Avila AL, de Carvalho PVR. Decentralizing referral prioritization to general practitioners at the primary care level: A qualitative case study based on the Grounded Theory. Work 2024; 77:1189-1203. [PMID: 37980591 DOI: 10.3233/wor-230228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Patient referral prioritizations is an essential process in coordinating healthcare delivery, since it organizes the waiting lists according to priorities and availability of resources. OBJECTIVE This study aims to highlight the consequences of decentralizing ambulatory patient referrals to general practitioners that work as family physicians in primary care clinics. METHODS A qualitative case study was carried out in the municipality of Rio de Janeiro. The ten health regions of Rio de Janeiro were visited during fieldwork, totalizing 35 hours of semi-structured interviews and approximately 70 hours of analysis based on the Grounded Theory. RESULTS The findings of this study show that the obstacles to adequate referrals are beyond the management of vacancies, ranging from the standardization of prioritization criteria to ensuring the proper employment of referral protocols in diverse locations assisted by overloaded health workers with different backgrounds and perceptions. Efforts in decentralizing patient referral to primary care still face the growing dilemmas and challenges of expanding the coverage of health services while putting pressure on risk assessment, as well as sustaining the autonomy of physicians' work while respecting the eligibility when ordering waiting lists. CONCLUSION A major strength of this work is on the method to organize and aggregate qualitative data using visual representations. Limitations concerning the reach of fieldwork in vulnerable and hardly accessible areas were overcame using snowball sampling techniques, making more participants accessible.
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Affiliation(s)
- Alessandro Jatobá
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Hugo Bellas
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rodrigo Arcuri
- Programa de Pós-Graduação em Engenharia de Produção (TPP), Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - André Luiz Avelino Sobral
- Programa de Pós-Graduação em Engenharia de Produção (TPP), Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - Bárbara Bulhões
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jaqueline Vianna
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula de Castro Nunes
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Paulo Victor Rodrigues de Carvalho
- Centro de Estudos Estratégicos Antônio Ivo de Carvalho (CEE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Instituto de Engenharia Nuclear (IEN), Rio de Janeiro, Brazil
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Munir K, Tighe L, Keane E. A single-center audit of a novel tonsil long-waiter outpatient clinic. Ir J Med Sci 2023:10.1007/s11845-023-03564-7. [PMID: 37987963 DOI: 10.1007/s11845-023-03564-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Outpatient waiting list figures have substantially increased over the last 3 years due to the effects of a global pandemic and cyber-hacking crisis. Multidisciplinary initiatives are essential to try to reduce the burden on overwhelmed medical and surgical specialties. OBJECTIVE The purpose of the study is as follows: (1) to demonstrate the potential for a problem-specific clinic to help ease the burden on an overwhelmed specialty and identify high-risk patients who may benefit from earlier surgical intervention and (2) to provide supervised clinical training to our clinical nurse specialist. METHODS A retrospective audit of outpatient referrals awaiting an appointment was conducted, and a new outpatient clinic was formed for patients referred with tonsil issues with or without additional complaints. RESULTS Two hundred ninety-five patients with an average waiting time of 14.4 months were offered an outpatient appointment over 5 months. Sixty-four percent (n = 189) attended their appointments, and 59.3% (n = 112) of these were listed for surgery. One hundred fifty-eight patients were able to be discharged back to the care of their general practitioners. DISCUSSION/CONCLUSION This outpatient clinic identified a large number of patients waiting significant periods of time for an outpatient appointment and allowed a definitive clinical decision to be made with most patients being either discharged or listed for surgery. Initiatives such as this offer the possibility of reducing the burden of long waiting times on individual institutions.
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Affiliation(s)
- Khalid Munir
- Department of Otorhinolaryngology, Head & Neck Surgery, Royal College of Surgeons, Dublin, Ireland.
- Department of Otorhinolaryngology, Sligo University Hospital, Sligo, Ireland.
| | - Linda Tighe
- Department of Otorhinolaryngology, Sligo University Hospital, Sligo, Ireland
| | - Emma Keane
- Department of Otorhinolaryngology, Sligo University Hospital, Sligo, Ireland
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Peipert A, Adams S, Lorenzo-Luaces L. "I would not want the mechanic to direct me to an engine repair manual": a qualitative analysis of provider perspectives on low-intensity treatments for patients on waiting lists. BMC Psychiatry 2023; 23:600. [PMID: 37592212 PMCID: PMC10436418 DOI: 10.1186/s12888-023-05055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Low-intensity treatments (LITs), such as bibliotherapy or online self-help, have the potential to reach more individuals than traditional face-to-face care by circumventing many of the common barriers to mental health treatment. Despite substantial research evidence supporting their usability and efficacy across several clinical presentations, prior work suggests that mental health providers rarely recommend LITs for patients waiting for treatment. METHODS The present study analyzed provider open responses to a prompt asking about perceived barriers, thoughts, and comments related to additional treatment resources for patients on treatment waiting lists. We surveyed 141 practicing mental health providers, 65 of whom responded to an open text box with additional thoughts on using LITs for patients on treatment waiting lists. Responses were qualitatively coded using a thematic coding process. RESULTS Qualitative outcomes yielded 11 codes: patient appropriateness, research evidence, feasibility, patient barriers, liability, patient personal contact, additional resources, positive attitudes, trust in programs, systemic problems, and downplaying distress. CONCLUSIONS Results suggest providers are predominantly concerned about the potential of suggesting a LIT that would be ultimately inappropriate for their patient due to a lack of assessment of the patient's needs. Furthermore, providers noted ambiguity around the legal and ethical liability of recommending a LIT to someone who may not yet be a patient. Guidelines and standards for recommending LITs to patients on treatment waiting lists may help address ambiguity regarding their use in routine care.
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Affiliation(s)
- Allison Peipert
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th Street, Bloomington, IN, 47405, USA
| | - Sydney Adams
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th Street, Bloomington, IN, 47405, USA
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th Street, Bloomington, IN, 47405, USA.
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7
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Han M, Jeong JC, Cho YY, Ahn C, Kim YH. Sex disparity in dialysis and kidney transplantation over 20 years in Korea. Kidney Res Clin Pract 2023; 42:512-518. [PMID: 37098676 PMCID: PMC10407634 DOI: 10.23876/j.krcp.22.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/17/2022] [Accepted: 11/01/2022] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Sex disparity is prevalent in organ transplantations worldwide. This study aimed to understand sex disparities in dialysis and kidney transplantation in Korea over the last 20 years. METHODS Data for incident dialysis, waiting list registration, and donors and recipients were retrospectively collected between January 2000 and December 2020 from the Korean Society of Nephrology end-stage renal disease registry and the database of the Korean Network for Organ Sharing. Data regarding the proportion of females for dialysis, waiting list, and kidney transplantation donors or recipients were analyzed using linear regression analysis. RESULTS The average proportion of females on dialysis over the past 20 years was 40.5%. The proportion of females on dialysis was 42.8% in 2000, and decreased to 38.2% in 2020, showing a decreasing trend. The average proportion of women on the waiting list was 38.4%, which was lower than that for dialysis. The average proportion of female recipients in living donor kidney transplantation and female living donors were 40.1% and 53.2%, respectively. The overall proportion of female donors in living donor kidney transplantation showed an increasing trend. However, there was no change in the proportion of female recipients in living donor kidney transplantation. CONCLUSION Sex disparities in organ transplantation exist, including an increasing trend of female donors in living donor kidney transplantation. Further studies are needed to identify the biological and socioeconomic factors involved to resolve these disparities.
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Affiliation(s)
- Miyeun Han
- Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jong Cheol Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yun Yung Cho
- Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea
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van Hulsen MAJ, Rohde KIM, van Exel J. Preferences for investment in and allocation of additional healthcare capacity. Soc Sci Med 2023; 320:115717. [PMID: 36716698 DOI: 10.1016/j.socscimed.2023.115717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
Policy makers need to make decisions regarding the allocation of scarce healthcare resources. We study preferences for investment in additional healthcare capacity and allocation between two regions, focusing on reducing waiting time for elective surgery for a physical health problem. We elicit preferences from a societal and an individual perspective, with unequal initial waiting times between the two regions. In an online survey, 1039 respondents were randomly assigned to one of three versions of the experiment: (1) a social planner perspective, placing respondents in the role of a policy maker; (2) an individual perspective where the respondent's own region was better off regarding initial waiting times; (3) an individual perspective where the individual's own region was worse off regarding initial waiting times. Respondents were asked to rank the status quo and five scenarios where the investment in additional capacity led to different distributions of shorter waiting times between regions. For all allocations we presented both the reduction in waiting time and the resulting final waiting time for both regions. We find that in version 1 of the experiment, preferences were in line with inequality aversion and Rawlsian preferences regarding final waiting time. In version 3, similar preferences were found, although here they also align with individualistic preferences. In version 2, preferences were more heterogeneous, with both individualistic and egalitarian preferences present. Concluding, individualistic and egalitarian preferences mostly concerned final waiting time. We therefore recommend policy makers to focus on the effect on final waiting time instead of the reduction of waiting time.
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Affiliation(s)
- Merel A J van Hulsen
- Erasmus School of Economics (ESE), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Research Institute of Management (ERIM), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Kirsten I M Rohde
- Erasmus School of Economics (ESE), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Research Institute of Management (ERIM), Erasmus University Rotterdam, Rotterdam, the Netherlands; Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Job van Exel
- Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Rotterdam, the Netherlands.
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Pontes MDDS, Soeira TP, Sampaio ML, Pratali RDR, Pompeu Y, Herrero CFPDS. The impacts of waiting for surgical correction of Adolescent Idiopathic Scoliosis and its repercussions for publicly funded health systems: systematic review. Eur Spine J 2023; 32:617-624. [PMID: 36520211 DOI: 10.1007/s00586-022-07487-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/14/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate, through a systematic review, the impact of the waiting time for Adolescent Idiopathic Scoliosis (AIS) surgical correction from the point of view of deformity evolution, treatment cost, and quality of life. METHODS PubMed, Embase, LILACS, SciELO, Scopus, Web of Science, LIVIVO, and Cochrane Library databases were searched by two researchers to select the articles. The eligibility criteria were: Patients diagnosed with AIS with indication for surgical correction and submitted to waiting lists until treatment. The risks of bias were evaluated using the Risk Of Bias In Non-randomized Studies-Interventions (ROBINS-I) tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to classify the level of the evidence for each outcome. The summary of the available evidence is presented in a narrative synthesis. RESULTS Six observational studies were included. In a Canadian study, the primary outcome was the need for additional spine surgery in patients who had to wait more than three months due to spine deformity progression. American researchers presented a sample of premenarcheal and skeletally immature patients with AIS showing increased Cobb angle and attributed this to a six-month waiting for the surgical treatment. Another study included 177 patients with AIS with a mean waiting time of 225.7 days. There was a worsening average of 7.7° ± 8.6° in Cobb angle, and there was a change in surgical plan in 28 patients, which increased surgical time. Studies that evaluated the treatment cost showed significantly higher mean costs in those who waited longer than six months. Regarding the quality of life, while waiting for surgery, a retrospective study found that patients who underwent surgery earlier showed better results in a questionnaire that assessed their quality of life compared to those who were still waiting. CONCLUSION Observational studies show that, in individuals who are on waiting lists for AIS surgery, there is a worsening of the spinal deformity (substantial evidence), an increasing cost of treatment (moderate evidence) and it may negatively impact patients' quality of life (insufficient evidence). Performing better methodological quality studies to investigate these outcomes can violate good research practices since randomized clinical trials on this subject have ethical limitations to be carried out. TRIAL REGISTRATION The authors declare that the systematic review protocol was registered at the international prospective register of systematic reviews (PROSPERO), CRD42020212134, and it was accepted for publication.
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Affiliation(s)
- Mariana Demétrio de Sousa Pontes
- Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, 11 Floor - Vila Monte Alegre - CEP 14048-900, Ribeirão Preto, SP, Brazil.
| | - Thabata Pasquini Soeira
- Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, 11 Floor - Vila Monte Alegre - CEP 14048-900, Ribeirão Preto, SP, Brazil
| | | | | | - Yuri Pompeu
- Hospital for Special Surgery, New York, NY, USA
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Wood RM. Supporting COVID-19 elective recovery through scalable wait list modelling: Specialty-level application to all hospitals in England. Health Care Manag Sci 2022. [PMID: 36205827 DOI: 10.1007/s10729-022-09615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/28/2022] [Indexed: 11/27/2022]
Abstract
The recovery of elective waiting lists represents a major challenge and priority for the health services of many countries. In England’s National Health Service (NHS), the waiting list has increased by 45% in the two years since the COVID-19 pandemic was declared in March 2020. Long waits associate with worse patient outcomes and can deepen inequalities and lead to additional demands on healthcare resources. Modelling the waiting list can be valuable for both estimating future trajectories and considering alternative capacity allocation strategies. However, there is a deficit within the current literature of scalable solutions that can provide managers and clinicians with hospital and specialty level projections on a routine basis. In this paper, a model representing the key dynamics of the waiting list problem is presented alongside its differential equation based solution. Versatility of the model is demonstrated through its calibration to routine publicly available NHS data. The model has since been used to produce regular monthly projections of the waiting list for every hospital trust and specialty in England.
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Canning P, Neary S, Mullaney P. Analysis of cataract referrals from community optometrists and general practitioners and subsequent clinic visit outcomes in a university hospital in the west of Ireland. Ir J Med Sci 2022. [PMID: 36173544 DOI: 10.1007/s11845-022-03175-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/22/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Studies published from hospitals in other countries have reported rates of between 69 and 90% of cataract referrals being listed for surgery (1-3). This potentially represents unnecessary outpatient appointments, time off work and transport costs for patients and carers (2). AIMS Our first primary endpoint was to assess the number of cataract referrals listed for surgery. Our second primary endpoint was to assess the number of cataract referrals which included the following: (i) that visual loss from the cataract resulted in a detrimental effect on the patient's lifestyle, (ii) that the patient was willing to have surgery and (iii) that the patient was symptomatic from their cataract. METHODS This project followed the Declaration of Helsinki. This was a retrospective study. RESULTS Between February 2021 and February 2022, 198 patients were seen in Mr. PM's cataract clinic. Overall, 129 patients (67.5%) were listed for cataract surgery. Forty-seven referrals (23.7%) reported that the cataract was having a detrimental effect on the patient's life and these patients were more likely to be listed for surgery (93.6% vs. 59.2%, p = 0.00). Twenty-five referrals (12.6%) reported that the patient was willing to undergo surgery and these patients were more likely to be listed for surgery (88% vs. 64.8%, p = 0.02). A total of 130 referrals (65.7%) reported that the patient was symptomatic from their cataract and these patients were more likely to be listed for surgery (81.5% vs. 38.3%, p = 0.00). CONCLUSIONS It is possible that an appropriately focussed referral form will aid in triaging cataract referrals and potentially reduce unnecessary appointments.
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Robinson D. Preventing treatment delays for benign gynaecological conditions. Case Rep Womens Health 2022; 36:e00448. [PMID: 36092376 PMCID: PMC9450483 DOI: 10.1016/j.crwh.2022.e00448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 01/03/2023] Open
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13
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Mariotti G, Siciliani L, Rebba V, Coretti S, Gentilini M. Consensus among clinicians on referrals' priority and use of digital decision-making support systems. Health Policy 2022; 126:906-914. [PMID: 35858954 DOI: 10.1016/j.healthpol.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/19/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022]
Abstract
The growing demand for referrals is a main policy concern in health systems. One approach involves the development of demand management tools in the form of clinical prioritization to regulate patient referrals from primary care to specialist care. For clinical prioritization to be effective, it is critical that general practitioners (GPs) assess patient priority in the same way as specialists. The progressive development of IT tools in clinical practice, in the form of electronic referrals support systems (e-RSS), can facilitate clinical prioritization. In this study, we tested if higher use of e-RSS or higher use of high-priority categories was associated with the degree of agreement and therefore consensus on clinical priority between GPs and specialists. We found that higher use by GPs of the e-RSS tool was positively associated with greater degree of priority agreement with specialists, while higher use of the high-priority categories was associated with lower degree of priority agreement with specialists. Furthermore, female GPs, GPs in association with others, and GPs using a specific electronic medical record showed higher agreement with specialists. Our study therefore supports the use of electronic referrals systems to improve clinical prioritization and manage the demand of specialist visits and diagnostic tests. It also shows that there is scope for reducing excessive use by GPs of high-priority categories.
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Affiliation(s)
- Giuliano Mariotti
- Department of Governance, LHU APSS, Viale Alcide Degasperi, 79, Trento 38123, Italy.
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, United Kingdom
| | - Vincenzo Rebba
- Department of Economics and Management "Marco Fanno" - University of Padua, and CRIEP (Inter-University Center for Research on Public Economics), Padua, Italy
| | - Silvia Coretti
- Department of Economics and Management "Marco Fanno", University of Padua, Italy; Epidemiology Service, LHU APSS, Viale Verona, Trentom, Italy
| | - Maria Gentilini
- Epidemiology Service, LHU APSS, Viale Verona, Trentom, Italy
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14
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Richards KL, Woolrych I, Allen KL, Schmidt U. A Delphi study to explore clinician and lived experience perspectives on setting priorities in eating disorder services. BMC Health Serv Res 2022; 22:788. [PMID: 35715780 DOI: 10.1186/s12913-022-08170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Due to scarce resources and high demand, priority setting in mental health services is necessary and inevitable. To date, no study has examined priority setting in eating disorder (ED) services specifically. Here, we evaluate the level of consensus and perceived relative importance of factors used to determine patient prioritisation in ED services, amongst clinicians and individuals with lived experience (LE) of an ED. Methods A three round Delphi study and a ranking task were used to determine the level of consensus and importance. Consensus was defined as > 80% agreement or disagreement. Items that reached consensus for agreement were ranked in order of importance from most to least important. Participants were 50 ED clinicians and 60 LE individuals. Participant retention across rounds 2, 3, and 4 were 92%, 85%, and 79%, respectively. Results Over three iterative rounds, a total of 87 statements about patient prioritisation were rated on a 5-point Likert-scale of agreement. Twenty-three items reached consensus in the clinician panel and 20 items reached consensus in the LE panel. The pattern of responding was broadly similar across the panels. The three most important items in both panels were medical risk, overall severity, and physical health deteriorating quickly. Clinicians tended to place greater emphasis on physical risk and early intervention whereas the LE panel focused more on mental health and quality of life. Conclusions Eating disorder services tend to prioritise patients based upon medical risk and severity, and then by the order in which patients are referred. Our findings align in some respects with what is observed in services, but diverge in others (e.g., prioritising on quality of life), providing important novel insights into clinician and LE opinions on waiting list prioritisation in EDs. More research is warranted to validate these findings using multi-criterion decision techniques and observational methods. We hope these findings provide a foundation for future research and encourage evidence-based conversations around priority setting in ED services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08170-4.
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15
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O'Riordan B, Reynolds IS, Hechtl D, Lecot FP, Arya S, Geoghegan J, Kennelly R. Short notice cancellations - an insight into Irish surgical waiting lists. Ir J Med Sci 2022; 192:807-810. [PMID: 35641839 PMCID: PMC9156352 DOI: 10.1007/s11845-022-03026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
Background The reasons underlying prolonged waiting lists for surgery in Ireland are multifactorial. Patient-related factors including non-attendances contribute in part to the current waiting times. Aims To determine the rate of short notice cancellation for day case surgery in a model 2 HSE hospital over a 1-month period and to implement an intervention to try and reduce the rate of cancellation. Methods The cancellation rate was documented over a 1-month period in the hospital. An intervention was then implemented, involving a phone call to the patient from a member of the surgical team to attempt to reduce the cancellation rate. Cancellations were re-audited after the implementation of the phone intervention. Results The initial audit revealed a cancellation rate of 39.7% during the first month prior to implementation of the phone intervention. A phone call intervention from a member of the surgical team was associated with a decrease in cancellations from 39.7 to 14.6% (p < 0.01). Conclusions While cancellations remained high even after our intervention, a simple phone call was effective and more than halved our cancellation rate. Future efforts need to focus on increasing awareness of patient responsibility for attending scheduled appointments and procedures.
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Affiliation(s)
- Brian O'Riordan
- Department of Surgery, St Columcille's Hospital, Loughlinstown, Co Dublin, Ireland. .,Department of Colorectal Surgery, St Vincent's University Hospital, Dublin 4, Ireland.
| | - Ian S Reynolds
- Department of Surgery, St Columcille's Hospital, Loughlinstown, Co Dublin, Ireland.,Department of Colorectal Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Daniel Hechtl
- Department of Surgery, St Columcille's Hospital, Loughlinstown, Co Dublin, Ireland.,Department of Colorectal Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Frederik P Lecot
- Department of Surgery, St Columcille's Hospital, Loughlinstown, Co Dublin, Ireland.,Department of Colorectal Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Shobhit Arya
- Department of Surgery, St Columcille's Hospital, Loughlinstown, Co Dublin, Ireland.,Department of Colorectal Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Justin Geoghegan
- Department of Surgery, St Columcille's Hospital, Loughlinstown, Co Dublin, Ireland.,Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Rory Kennelly
- Department of Surgery, St Columcille's Hospital, Loughlinstown, Co Dublin, Ireland.,Department of Colorectal Surgery, St Vincent's University Hospital, Dublin 4, Ireland
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16
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Clement ND, Skinner JA, Haddad FS, Simpson AHRW. Prioritization versus rationing of healthcare - elective surgery is not optional surgery : how should priority be assessed to ensure equity? Bone Joint Res 2022; 11:301-303. [PMID: 35579001 PMCID: PMC9130670 DOI: 10.1302/2046-3758.115.bjr-2022-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - John A Skinner
- Department of Orthopaedics, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Fares S Haddad
- Department of Orthopaedics, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal , London, UK
| | - A Hamish R W Simpson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
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17
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Beaumont T, Tian E, Kumar S. "It's messing with my physical health. It's messing with my sex life": Women's perspectives about, and impact of, pelvic health issues whilst awaiting specialist care. Int Urogynecol J 2022. [PMID: 35362768 DOI: 10.1007/s00192-022-05176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
Introduction and hypothesis Pelvic health conditions are a common health complaint among women worldwide, and conservative management is recognised as first-line treatment. There is often a time lag between referral from general practitioners to specialist consultation and conservative therapy. Therefore, the aim of this research was to explore perspectives from women with pelvic health conditions while they wait for specialist input, specifically about their understanding of their condition and its impact. Methods This research was underpinned by a qualitative descriptive methodology. Individual semi-structured interviews were conducted with women with pelvic health conditions who were waiting for specialist gynaecology consultation. Results A total of 11 women shared their perspectives about, and their understanding of, their condition and its impact. Thematic analysis of the interview data identified a variety of experiences and perspectives of women waiting to see the gynaecologist. These perspectives were categorised into four different themes: drivers to seek help, understanding the condition, experience/feeling being on the waiting list and expectations from the gynaecology team. Conclusion This study identified the main drivers for seeking help were worsening and/or persistent symptoms. Participants were able to articulate their symptoms, identify possible causes and describe various treatment options, and amenable to alternate treatment options. This research sheds light on the devastating impact of pelvic health conditions on women, which may be amplified while waiting to seek specialist input. There appears to be a need for health services to better support these women during this time of waiting.
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18
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Hodgson H, Golmohamad R, Gulati A, Pandit H, Palan J, Giannoudis P, Howard A. Patient perspectives on elective orthopaedic surgery during the COVID-19 pandemic: a comparison between patients from different ethnic backgrounds. Ann R Coll Surg Engl 2021; 104:346-352. [PMID: 34939846 DOI: 10.1308/rcsann.2021.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Suspending elective surgery during the first wave of coronavirus (COVID-19) led to record-breaking numbers of patients on waiting lists. Patients in Black, Asian and minority ethnic (BAME) groups are disproportionately affected by COVID-19. This study compares the perspectives of patients from different ethnic backgrounds on the return to elective surgery. METHODS Some 151 patients were sampled from cancelled operating lists at two hospitals. Semi-structured interviews focused on the impact of COVID-19, and views about resuming elective surgery. The Generalized Anxiety Disorder 7-iten Scale (GAD-7) measured anxiety. A visual analogue scale (VAS) measured pain. Data were analysed using exploratory thematic analysis. RESULTS Fewer BAME patients were pleased about restarting surgery, compared with white patients (47.3% vs 82.6%, p<0.001), and a greater proportion wanted to postpone their operation until after the pandemic (21.8% vs 9.3%, p=0.048). White/white British patients had higher GAD-7 scores (2 (0-21) vs 0 (0-16), p=0.009). Black/Black British patients had significantly higher VAS scores compared with white/white British and Asian/Asian British patients (85 vs 75 vs 70 respectively, p<0.05). CONCLUSION The delay in surgery due to the pandemic has had a devastating impact on patients awaiting operations. The variation in pain and anxiety levels between ethnic groups must be addressed when redesigning services to avoid discrepancies in postoperative clinical outcomes. Patients in BAME groups are more likely to postpone their operation, which may lead to further health deterioration, psychosocial and socio-economic consequences, and poorer clinical outcomes following surgery. The thoughts, feelings and concerns of all must be considered when redesigning services to prevent health inequalities between patients from different backgrounds.
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Affiliation(s)
- H Hodgson
- Leeds Teaching Hospitals NHS Trust, UK
| | | | - A Gulati
- Sandwell and West Birmingham NHS Trust, UK
| | - H Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - J Palan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - P Giannoudis
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - A Howard
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK.,NDORMS, University of Oxford, UK
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19
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Acuna JA, Zayas-Castro JL, Feijoo F, Sankaranarayanan S, Martinez R, Martinez DA. The Waiting Game - How Cooperation Between Public and Private Hospitals Can Help Reduce Waiting Lists. Health Care Manag Sci 2021; 25:100-125. [PMID: 34401992 PMCID: PMC8367652 DOI: 10.1007/s10729-021-09577-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/22/2021] [Indexed: 12/02/2022]
Abstract
Prolonged waiting to access health care is a primary concern for nations aiming for comprehensive effective care, due to its adverse effects on mortality, quality of life, and government approval. Here, we propose two novel bargaining frameworks to reduce waiting lists in two-tier health care systems with local and regional actors. In particular, we assess the impact of 1) trading patients on waiting lists among hospitals, the 2) introduction of the role of private hospitals in capturing unfulfilled demand, and the 3) hospitals’ willingness to share capacity on the system performance. We calibrated our models with 2008–2018 Chilean waiting list data. If hospitals trade unattended patients, our game-theoretic models indicate a potential reduction of waiting lists of up to 37%. However, when private hospitals are introduced into the system, we found a possible reduction of waiting lists of up to 60%. Further analyses revealed a trade-off between diagnosing unserved demand and the additional expense of using private hospitals as a back-up system. In summary, our game-theoretic frameworks of waiting list management in two-tier health systems suggest that public–private cooperation can be an effective mechanism to reduce waiting lists. Further empirical and prospective evaluations are needed.
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Affiliation(s)
- Jorge A Acuna
- Industrial and Management Systems Engineering, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL, 33620, USA.
| | - José L Zayas-Castro
- Industrial and Management Systems Engineering, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL, 33620, USA
| | - Felipe Feijoo
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | | | | | - Diego A Martinez
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile.,Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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20
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Villena F, Pérez J, Lagos R, Dunstan J. Supporting the classification of patients in public hospitals in Chile by designing, deploying and validating a system based on natural language processing. BMC Med Inform Decis Mak 2021; 21:208. [PMID: 34210317 PMCID: PMC8252255 DOI: 10.1186/s12911-021-01565-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background In Chile, a patient needing a specialty consultation or surgery has to first be referred by a general practitioner, then placed on a waiting list. The Explicit Health Guarantees (GES in Spanish) ensures, by law, the maximum time to solve 85 health problems. Usually, a health professional manually verifies if each referral, written in natural language, corresponds or not to a GES-covered disease. An error in this classification is catastrophic for patients, as it puts them on a non-prioritized waiting list, characterized by prolonged waiting times. Methods To support the manual process, we developed and deployed a system that automatically classifies referrals as GES-covered or not using historical data. Our system is based on word embeddings specially trained for clinical text produced in Chile. We used a vector representation of the reason for referral and patient's age as features for training machine learning models using human-labeled historical data. We constructed a ground truth dataset combining classifications made by three healthcare experts, which was used to validate our results. Results The best performing model over ground truth reached an AUC score of 0.94, with a weighted F1-score of 0.85 (0.87 in precision and 0.86 in recall). During seven months of continuous and voluntary use, the system has amended 87 patient misclassifications. Conclusion This system is a result of a collaboration between technical and clinical experts, and the design of the classifier was custom-tailored for a hospital's clinical workflow, which encouraged the voluntary use of the platform. Our solution can be easily expanded across other hospitals since the registry is uniform in Chile.
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Affiliation(s)
- Fabián Villena
- Center for Mathematical Modeling - CNRS UMI2807, Faculty of Physical and Mathematical Sciences, University of Chile, Santiago, Chile.,Center for Medical Informatics and Telemedicine, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Jorge Pérez
- Computer Science Department, Faculty of Physical and Mathematical Sciences, University of Chile, Santiago, Chile.,Millennium Institute for Foundational Research on Data, Santiago, Chile
| | - René Lagos
- Digital Health Unit, South East Metropolitan Health Service, Santiago, Chile
| | - Jocelyn Dunstan
- Center for Mathematical Modeling - CNRS UMI2807, Faculty of Physical and Mathematical Sciences, University of Chile, Santiago, Chile. .,Center for Medical Informatics and Telemedicine, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile.
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21
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Abstract
AIMS Due to widespread cancellations in elective orthopaedic procedures, the number of patients on waiting list for surgery is rising. We aim to determine and quantify if disparities exist between inpatient and day-case orthopaedic waiting list numbers; we also aim to determine if there is a 'hidden burden' that already exists due to reductions in elective secondary care referrals. METHODS Retrospective data were collected between 1 April 2020 and 31 December 2020 and compared with the same nine-month period the previous year. Data collected included surgeries performed (day-case vs inpatient), number of patients currently on the orthopaedic waiting list (day-case vs inpatient), and number of new patient referrals from primary care and therapy services. RESULTS There was a 52.8% reduction in our elective surgical workload in 2020. The majority of surgeries performed in 2020 were day case surgeries (739; 86.6%) with 47.2% of these performed in the independent sector on a 'lift and shift' service. The total number of patients on our waiting lists has risen by 30.1% in just 12 months. As we have been restricted in performing inpatient surgery, the inpatient waiting lists have risen by 73.2%, compared to a 1.6% rise in our day-case waiting list. New patient referral from primary care and therapy services have reduced from 3,357 in 2019 to 1,722 in 2020 (49.7% reduction). CONCLUSION This study further exposes the increasing number of patients on orthopaedic waiting lists. We observed disparities between inpatient and day-case waiting lists, with dramatic increases in the number of inpatients on the waiting lists. The number of new patient referrals has decreased, and we predict an influx of referrals as the pandemic eases, further adding to the pressure on inpatient waiting lists. Robust planning and allocation of adequate resources is essential to deal with this backlog. Cite this article: Bone Jt Open 2021;2(7):530-534.
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Affiliation(s)
- Matthew Hampton
- Rotherham District General Hospital, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Ella Riley
- University of Sheffield Medical School, Sheffield, UK
| | - Naren Garneti
- Rotherham District General Hospital, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Alexander Anderson
- Rotherham District General Hospital, Rotherham NHS Foundation Trust, Rotherham, UK
| | - Kevin Wembridge
- Rotherham District General Hospital, Rotherham NHS Foundation Trust, Rotherham, UK
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22
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Clifford RE, Rajput K, Naing CY, MacDonald K, Pantak T, Kaul A. Reducing waiting lists for laparoscopic cholecystectomy: An intensive approach to aid COVID-19 recovery. Eur Surg 2021; 54:113-116. [PMID: 34149832 PMCID: PMC8202224 DOI: 10.1007/s10353-021-00722-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 12/24/2022]
Abstract
Background Laparoscopic cholecystectomy is one of the most frequently performed operations in the United Kingdom, commonly due to symptomatic gallstones. Delay between diagnosis and definitive surgical intervention often leads to a significant readmission rate, growing financial burden and increased complexity of the ultimate surgical intervention. Resource reallocation and reduced operational capacity during the coronavirus disease 2019 (COVID-19) pandemic has led to an impending waiting list crisis. Methods In an attempt to address the backlog of cases, five intensive dedicated operating lists were allocated for laparoscopic cholecystectomies across a weekend in October 2020 at a single Trust. Prospective data were collected to include baseline demographics, operative procedure, 30-day post-operative outcomes and financial implications. Results A total of 21 cholecystectomies were performed in total, with a majority ASA 2 (American Society of Anaesthesiologists) for predominantly biliary colic indication. All were completed laparoscopically, with a 90.5% rate for complete resection. There were no reported on-table complications and 81.0% of patients discharged as a day case. Thirty day follow-up revealed a complication rate of 9.5%, with 2 patients requiring oral antibiotics for a superficial wound infection. The 30 day COVID-19 rate was 14.3%. Compared to completion on an average weekday list, the total weekend was estimated to have saved over £70,000 in overall costs. Conclusion Our study showed that weekend focused operating, with a caveat of careful patient selection and high-quality multidisciplinary working, can be a feasible solution to long waiting lists due to COVID-19 pandemic. It was safe, with avoidance of increased burden on emergency resources, and significantly increased theatre efficiency.
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Affiliation(s)
| | - Kunal Rajput
- St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, L35 5DR Prescot, UK
| | - Chyu Yan Naing
- St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, L35 5DR Prescot, UK
| | - Karen MacDonald
- St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, L35 5DR Prescot, UK
| | - Thomas Pantak
- St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, L35 5DR Prescot, UK
| | - Anil Kaul
- St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, L35 5DR Prescot, UK
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23
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Kraus-Fischer G, Alfonso-Ballester R, Mora-Oliver I, Cassinello-Fernández N, Ortega-Serrano J. Effectiveness and efficiency of a special program to reduce the bariatric surgery waiting list at a tertiary hospital. Cir Esp 2021; 99:276-281. [PMID: 32674840 PMCID: PMC7358759 DOI: 10.1016/j.ciresp.2020.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/15/2020] [Accepted: 05/30/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Bariatric surgery is one of the most common surgical practices in Spain. However, this procedure currently has longest delay on surgical waiting lists (SWL). We have developed a special surgical program that aims to reduce this waiting list and to assess the economic and clinical repercussions in a high-volume bariatric surgery unit. METHODS A three-month prospective study was carried out comparing outcomes, results and perioperative resources consumed for 45 patients who underwent bariatric surgery. The patients were divided into 2 groups: patients who underwent the standard procedure in the operating room, and patients treated in the special program. Epidemiological, healthcare and economic factors were taken into account. RESULTS Two homogeneous groups of patients were operated on, successfully reducing the SWL. Morbidity was similar in both groups and the average cost of the surgeries performed was €5,331.40; in the standard group, the cost was €5,372.50±€798.10, and the cost of the special program group was €5,290.30±€685.10, with no significant differences. CONCLUSIONS In hospitals with a high volume of bariatric surgery, it is feasible to incorporate special surgical programs that are able to reduce surgical waiting lists, while maintaining quality criteria and without incurring a greater expense to the healthcare system.
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Affiliation(s)
- Gabriel Kraus-Fischer
- Unidad de Cirugía Endocrina y Bariátrica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Raquel Alfonso-Ballester
- Unidad de Cirugía Endocrina y Bariátrica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, Valencia, España; Departamento de Cirugía, Universidad de Valencia, Valencia, España
| | - Isabel Mora-Oliver
- Unidad de Cirugía Endocrina y Bariátrica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Norberto Cassinello-Fernández
- Unidad de Cirugía Endocrina y Bariátrica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, Valencia, España; Departamento de Cirugía, Universidad de Valencia, Valencia, España
| | - Joaquín Ortega-Serrano
- Unidad de Cirugía Endocrina y Bariátrica, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, Valencia, España; Departamento de Cirugía, Universidad de Valencia, Valencia, España.
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24
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Pietrzak JRT, Maharaj Z, Erasmus M, Sikhauli N, Cakic JN, Mokete L. Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic. World J Orthop 2021; 12:152-168. [PMID: 33816142 PMCID: PMC7995341 DOI: 10.5312/wjo.v12.i3.152] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/06/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Elective total joint arthroplasty (TJA) procedures have been postponed as part of the coronavirus disease 2019 (COVID-19) response to avert healthcare system collapse. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures comprise the highest volume of elective procedures performed at health care facilities worldwide.
AIM To determine the demand for TJA despite the pandemic and the impact of surgery postponement on physical and mental health.
METHODS We conducted a prospective cross-sectional telephonic interview-based study on patients awaiting THA and TKA at an academic institution in South Africa. The questionnaire consisted of four sections. The first section recorded baseline demographic data and medical co-morbidities, the length of time spent awaiting TJA, and the patients’ desire to undergo elective surgery despite the COVID-19 pandemic. Section 2 and Section 3 assessed the patients’ current physical and mental health, respectively, as a consequence of deferred surgical intervention. The last section established the patients’ perception of the healthcare system’s response to the COVID-19 pandemic and necessity to postpone elective surgery. Patients received counseling and education on the current state of surgery during the COVID-19 pandemic and associated risks. Thereafter, patients were once again asked about their desire to undergo TJA during the COVID-19 pandemic.
RESULTS We included 185 patients (65.95% female; mean age: 50.28 years) awaiting TJA for a mean of 26.42 ± 30.1 mo. Overall, 88.65% of patients wanted TJA despite the COVID-19 pandemic. Patients awaiting TJA for 1-3 years were 3.3-fold more likely to want surgery than those waiting < 1 year (P < 0.000). Patients with comorbidities were 8.4-fold less likely to want TJA than those with no comorbidities (P = 0.013). After receiving education, the patients wanting TJA decreased to 54.05%. Patients who changed their opinion after education had less insight on the increased morbidity (P = 0.046) and mortality (P = 0.001) associated with COVID-19. Despite awaiting TJA for shorter period (24.7 ± 20.38 mo), patients who continued to demand TJA had greater pain (P < 0.000) and decreased function (P = 0.043) since TJA postponement.
CONCLUSION There is deterioration in health for patients, who have had elective procedures postponed during the COVID-19 pandemic. Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.
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Affiliation(s)
| | - Zia Maharaj
- Department of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, Gauteng, South Africa
| | - Magdalena Erasmus
- Department of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, Gauteng, South Africa
| | - Nkhodiseni Sikhauli
- Department of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, Gauteng, South Africa
| | - Josip Nenad Cakic
- Department of Orthopaedic Surgery, Life Fourways, Johannesburg 2193, Gauteng, South Africa
| | - Lipalo Mokete
- Department of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, Gauteng, South Africa
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Kinghorn AF, Mercer ST, Yasin T, John A, Trickett RW. Is it safe yet? Patient readiness and perceptions about returning to hospital for planned orthopaedic care. Ann R Coll Surg Engl 2021; 103:332-336. [PMID: 33682444 DOI: 10.1308/rcsann.2020.7025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION COVID-19 has necessitated significant changes to healthcare delivery but little is known regarding patient opinions of risks compared with benefits. This study investigates patient perceptions concerning attendance for planned orthopaedic surgery during the COVID-19 pandemic. MATERIALS AND METHODS A total of 250 adult patients from the elective orthopaedic waiting list at Cardiff and Vale University Health Board were telephoned during lockdown. They were risk stratified for COVID-19 based on British Orthopaedic Association guidance and a discussion was held to determine patient willingness to proceed with surgery. The primary outcome measure was patients' willingness to proceed. RESULTS Of the total number telephoned, 196 patients were included in the study, with a mean age of 57.4 years; 129 patients were willing to attend for surgery, leaving over one-third wishing to cancel or defer. The most frequent reason given for not wishing to attend was fear of contracting COVID-19. There was a statistically significant difference in the willingness to proceed observed with increasing clinical risk (χ2(3) = 50.073, p = .000) with almost double the expected count of unwilling to proceed in the high and very high risk groups, equalled by half the expected count in the low risk group. DISCUSSION This study illustrates the variable and personal decisions that patients are making about orthopaedic care because of COVID-19. It highlights the need for change to departmental processes regarding recommencement of planned surgical lists. It also reconfirms the importance of regular communication and shared decision making between a well-informed patient and a holistic orthopaedic team.
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Affiliation(s)
- A F Kinghorn
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S T Mercer
- Cardiff and Vale University Health Board, Cardiff, UK
| | - T Yasin
- Cardiff and Vale University Health Board, Cardiff, UK
| | - A John
- Cardiff and Vale University Health Board, Cardiff, UK
| | - R W Trickett
- Cardiff and Vale University Health Board, Cardiff, UK
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López-Cano M, Rodrigues-Gonçalves V, Verdaguer-Tremolosa M, Petrola-Chacón C, Rosselló-Jiménez D, Saludes-Serra J, Armengol-Carrasco M, Garcia-Alamino JM. Prioritization criteria of patients on scheduled waiting lists for abdominal wall hernia surgery: a cross-sectional study. Hernia 2021. [PMID: 33599898 DOI: 10.1007/s10029-021-02378-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/30/2021] [Indexed: 12/21/2022]
Abstract
Purpose Long delays in waiting lists have a negative impact on the principles of equity and providing timely access to care. This study aimed to assess waiting lists for abdominal wall hernia repair (incisional ventral vs. inguinal hernia) to define explicit prioritization criteria. Methods A cross-sectional single-center study was designed. Patients in the waiting list for incisional/ventral hernia (n = 42) and inguinal hernia (n = 50) repair were interviewed by phone and completed health-related quality of life (HRQoL) questionnaires (EQ-5D, COMI-hernia, HerQLes) as a measure of severity. Priority was measured as hernia complexity, patient frailty using the modified frailty index (mFI-11), and the consumption of analgesics for hernia. Results The mean (SD) time on the waiting list was 5.5 (3.2) months (range 1–14). Complex hernia was present in 34.8% of the patients. HRQoL was moderately poor in patients with incisional/ventral hernia (mean HerQL score 66.1), whereas it was moderately good in patients with inguinal hernia (mean COMI-hernia score 3.40). The use of analgesics was higher in patients with incisional/ventral hernia as compared with those with inguinal hernia (1.48 [0.54] vs. 1.31 [0.51], P = 0.021). Worst values of mFI were associated with inguinal hernia as compared with incisional/ventral hernia (0.21 [0.14] vs. 0.12 [0.11]; P = 0.010). Conclusion Explicit criteria for prioritization in the waiting lists may be the consumption of analgesics for patients with incisional/ventral hernia and frailty for patients with inguinal hernia. A reasonable approach seems to establish separate waiting lists for incisional/ventral hernia and inguinal hernia repair.
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27
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Mullins CF, Harmon D, O'Connor T. Quantifying the impact of COVID-19 on chronic pain services in the Republic of Ireland. Ir J Med Sci 2021. [PMID: 33544332 DOI: 10.1007/s11845-021-02509-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/06/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION During the COVID-19 pandemic, most medical services were shut down and resources were redistributed. Closures included pain management departments where many staff were redeployed. The aim of this study was to assess the impact of COVID-19 on chronic pain services in the Republic of Ireland. METHODS An online survey was sent to pain consultants working in public hospitals in the Republic of Ireland between the 22nd and 28th September 2020. RESULTS We received responses from 18 consultants from all 15 public hospitals in the Republic of Ireland with chronic pain services. Procedural volume during lockdown fell to 26% of pre-COVID levels. This had recovered somewhat by the time of the survey to 71%. Similarly, in-person outpatient clinic volume fell to 10% of per-COVID numbers and recovered to 50%. On average, 39% of public hospital activity was made up for by the availability of private hospitals. This varied significantly across the country. The use of telemedicine increased significantly during the pandemic. Before COVID, on average, 13% of outpatient clinic volume was composed of telephone or video consultations. This increased to 46% at the time of the survey. CONCLUSION This survey of consultant pain physicians in the Republic of Ireland has revealed how chronic pain services have been affected during the pandemic and how they have evolved.
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Logishetty K, Edwards TC, Subbiah Ponniah H, Ahmed M, Liddle AD, Cobb J, Clark C. How to prioritize patients and redesign care to safely resume planned surgery during the COVID-19 pandemic. Bone Jt Open 2021; 2:134-140. [PMID: 33630719 PMCID: PMC7925213 DOI: 10.1302/2633-1462.22.bjo-2020-0200.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aims Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites. Methods A multidisciplinary surgical prioritization committee developed the SPAG, incorporating procedural urgency, shared decision-making, patient safety, and biopsychosocial factors; and applied it to 1,142 adult patients awaiting orthopaedic surgery. Patients were stratified into four priority groups and underwent surgery at three COVID-free sites, including one with access to a high dependency unit (HDU) or intensive care unit (ICU) and specialist resources. Safety was assessed by the number of patients requiring inpatient postoperative HDU/ICU admission, contracting COVID-19 within 14 days postoperatively, and mortality within 30 days postoperatively. Results A total of 1,142 patients were included, 47 declined surgery, and 110 were deemed high-risk or requiring specialist resources. In the ten-week study period, 28 high-risk patients underwent surgery, during which 68% (13/19) of Priority 2 (P2, surgery within one month) patients underwent surgery, and 15% (3/20) of P3 (< three months) and 16% (11/71) of P4 (> three months) groups. Of the 1,032 low-risk patients, 322 patients underwent surgery. Overall, 21 P3 and P4 patients were expedited to ‘Urgent’ based on biopsychosocial factors identified by the SPAG. During the study period, 91% (19/21) of the Urgent group, 52% (49/95) of P2, 36% (70/196) of P3, and 26% (184/720) of P4 underwent surgery. No patients died or were admitted to HDU/ICU, or contracted COVID-19. Conclusion Our widely generalizable model enabled the restart of planned surgery during the COVID-19 pandemic, without compromising patient safety or excluding high-risk or complex cases. Patients classified as Urgent or P2 were most likely to undergo surgery, including those deemed high-risk. This model, which includes assessment of biopsychosocial factors alongside disease severity, can assist in equitably prioritizing the substantial list of patients now awaiting planned orthopaedic surgery worldwide. Cite this article: Bone Jt Open 2021;2(2):134–140.
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Affiliation(s)
- Kartik Logishetty
- MSk lab, Imperial College London, London, UK.,Frimley Health NHS Foundation Trust, Frimley, UK
| | - Thomas C Edwards
- MSk lab, Imperial College London, London, UK.,Frimley Health NHS Foundation Trust, Frimley, UK
| | | | | | | | - Justin Cobb
- MSk lab, Imperial College London, London, UK
| | - Callum Clark
- Frimley Health NHS Foundation Trust, Frimley, UK
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29
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Madanipour S, Al-Obaedi O, Ayub A, Iranpour F, Subramanian P. Resuming elective hip and knee arthroplasty in the COVID-19 era: a unique insight into patient risk aversion and sentiment. Ann R Coll Surg Engl 2021; 103:104-109. [PMID: 33185459 PMCID: PMC9773923 DOI: 10.1308/rcsann.2020.7012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION There has been guidance from the government and orthopaedic community on how best to ensure the safety of our patients and colleagues as we recommence elective surgery in the UK. The primary aim was to determine what proportion of patients feel they should proceed with their elective hip and knee arthroplasty surgery during the COVID-19 climate. The secondary aim was to investigate what variables affected this decision. METHODS Patient information from a single surgeon's waiting list in a district general hospital were recorded. A standardised telephone discussion was had with all the patients noting the severity of pain and the potential reasons for not wanting to proceed with surgery. RESULTS A total of 70.6% (96/136) of patients wished to proceed with surgery; 29.4% (40/136) did not wish to proceed. The decision to proceed with surgery was not correlated with sex, American Society of Anesthesiologists grade or COVID-19 risk. Those who wished to proceed with surgery had a mean age of 68.5 years while those who did not had a mean age of 72.4 years (P = 0.03). Within the matched subgroups, patients under the age of 70 years were more willing to proceed with primary hip arthroplasty surgery (87.9%) compared with primary knee arthroplasty surgery (57.1%; P = 0.007); 75% of the patients who did not wish to proceed with surgery expressed concerns about perioperative COVID-19 infection. CONCLUSION There is a significant proportion of arthroplasty patients on waiting lists who would be willing to accept the increased risks associated with COVID-19 to undergo surgery on an urgent basis. The subgroup of younger patients awaiting hip arthroplasty is more willing than those awaiting knee arthroplasty to proceed with surgery.
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Affiliation(s)
- S Madanipour
- Trauma and Orthopaedics, Royal Free NHS Trust (Barnet and Chase Farm Hospitals), Barnet, UK
| | - O Al-Obaedi
- Trauma and Orthopaedics, Royal Free NHS Trust (Barnet and Chase Farm Hospitals), Barnet, UK
| | - A Ayub
- Trauma and Orthopaedics, Royal Free NHS Trust (Barnet and Chase Farm Hospitals), Barnet, UK
| | - F Iranpour
- Trauma and Orthopaedics, Royal Free NHS Trust (Barnet and Chase Farm Hospitals), Barnet, UK
| | - P Subramanian
- Trauma and Orthopaedics, Royal Free NHS Trust (Barnet and Chase Farm Hospitals), Barnet, UK
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30
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Wongsiriroj S, Grillo E, Levi S, Zielman R, Lahouiri E, Marchina M, Pedrazzoli M, Ferraris M. Management of Migraine and the Accessibility of Specialist Care: Findings from an Extended Multinational Survey (My Migraine Center Survey). Neurol Ther 2020; 9:551-565. [PMID: 32767268 PMCID: PMC7606425 DOI: 10.1007/s40120-020-00205-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The parent study was a survey in 28 headache centers (6 countries) which identified five potential root causes for long waiting lists that limit patient access to specialist care. Here we performed an extension of the parent study to increase the panel of centers contacted, the representativeness of the analysis, and the statistical validity of the results, and to explore the role of dedicated headache clinics, triage, and specialized nurses. METHODS We conducted a 19-question survey using a sample of 239 headache centers (16 countries). The five-area framework identified in the parent study was confirmed and further developed by describing treatment center archetypes according to their setting (general neurology versus dedicated clinic) and resources available within the center (number of healthcare professional [HCPs] full-time-equivalent positions). RESULTS In total, 474 HCPs were interviewed across 16 countries. The proportion of patients with chronic migraine and episodic migraine varied across centers and countries. There was limited access to specialized centers in this enlarged sample; with global average waiting list of 3.7 months for the first visit and 2.5 months for the follow-up visit. Long waiting lists for headache patient care is a major issue in several countries, with the waiting lists for new patient visits extending up to 14 months. The presence of a dedicated nurse was correlated positively with the use of triage for prioritization of patient access (correlation coefficient: 0.85) and completing migraine diary (0.71). CONCLUSION This study confirmed differences across treatment center archetypes in terms of patients, waiting lists, level of delegation to nurse, and patient education and compliance, and provides support for the potential benefit of dedicated clinical settings for headache patients. The survey highlighted the potential role of nurses in patient education and waiting list prioritization, consequently benefiting headache centers.
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31
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Baltruschat I, Steinmeister L, Nickisch H, Saalbach A, Grass M, Adam G, Knopp T, Ittrich H. Smart chest X-ray worklist prioritization using artificial intelligence: a clinical workflow simulation. Eur Radiol 2021; 31:3837-45. [PMID: 33219850 DOI: 10.1007/s00330-020-07480-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/15/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022]
Abstract
Objective The aim is to evaluate whether smart worklist prioritization by artificial intelligence (AI) can optimize the radiology workflow and reduce report turnaround times (RTATs) for critical findings in chest radiographs (CXRs). Furthermore, we investigate a method to counteract the effect of false negative predictions by AI—resulting in an extremely and dangerously long RTAT, as CXRs are sorted to the end of the worklist. Methods We developed a simulation framework that models the current workflow at a university hospital by incorporating hospital-specific CXR generation rates and reporting rates and pathology distribution. Using this, we simulated the standard worklist processing “first-in, first-out” (FIFO) and compared it with a worklist prioritization based on urgency. Examination prioritization was performed by the AI, classifying eight different pathological findings ranked in descending order of urgency: pneumothorax, pleural effusion, infiltrate, congestion, atelectasis, cardiomegaly, mass, and foreign object. Furthermore, we introduced an upper limit for the maximum waiting time, after which the highest urgency is assigned to the examination. Results The average RTAT for all critical findings was significantly reduced in all prioritization simulations compared to the FIFO simulation (e.g., pneumothorax: 35.6 min vs. 80.1 min; p < 0.0001), while the maximum RTAT for most findings increased at the same time (e.g., pneumothorax: 1293 min vs 890 min; p < 0.0001). Our “upper limit” substantially reduced the maximum RTAT in all classes (e.g., pneumothorax: 979 min vs. 1293 min/1178 min; p < 0.0001). Conclusion Our simulations demonstrate that smart worklist prioritization by AI can reduce the average RTAT for critical findings in CXRs while maintaining a small maximum RTAT as FIFO. Key Points • Development of a realistic clinical workflow simulator based on empirical data from a hospital allowed precise assessment of smart worklist prioritization using artificial intelligence. • Employing a smart worklist prioritization without a threshold for maximum waiting time runs the risk of false negative predictions of the artificial intelligence greatly increasing the report turnaround time. • Use of a state-of-the-art convolution neural network can reduce the average report turnaround time almost to the upper limit of a perfect classification algorithm (e.g., pneumothorax: 35.6 min vs. 30.4 min).
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Llanos S, Galán-Olleros M, Manrique E, Celada R, Galeote JE, Marco F. Renunciations in forefoot surgery. Critical analysis of surgical waiting lists. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:75-84. [PMID: 33177010 DOI: 10.1016/j.recot.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/17/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The high prevalence of forefoot pathology generates long surgical waiting lists (SWL). We have detected a considerable number of patients who withdraw surgery, which creates an important distortion in our activity and high expenditure of resources. Our objective is to study the factors related to these resignations, as well as, compare them with other pathologies of high prevalence and ambulatory surgical treatment: carpal tunnel syndrome (CTS) and internal meniscopathy (IM). MATERIAL AND METHODS Retrospective study of the surgical cancellations on 2,399 patients included in the SWL of the Foot and Ankle Unit of our center for forefoot surgery, between January/2014 and March/2018, both included. RESULTS We have found 389 renunciations, which represent 16.22% of the inclusions in SWL, with 84.83% of women. The pathologies with the highest rate of resignation have been Morton metatarsalgia (24%) and hallux rigidus (20.16%). The most frequent pathology, hallux valgus, records 15.96% of resignations that occur mostly between 6 and 9 months. In the CTS and IM, the resignation rate has been 17.42 and 8.92%, respectively, with higher resignation rates in the first 3 months. CONCLUSIONS The withdrawal of a scheduled intervention on the forefoot registers a high frequency in our environment, which can be related to factors such as the type of pathology, its natural history, response to orthopedic interventions, time in LEQ, and other non-specific ones on which we must investigate, to rationalize and establish duties in our SWL.
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Affiliation(s)
- S Llanos
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
| | - M Galán-Olleros
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - E Manrique
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - R Celada
- Servicio de Admisión y Documentación clínica. Hospital Clínico San Carlos, Madrid, España
| | - J E Galeote
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - F Marco
- Unidad de Pie y Tobillo. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
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Harding KE, Snowdon DA, Prendergast L, Lewis AK, Kent B, Leggat SF, Taylor NF. Sustainable waiting time reductions after introducing the STAT model for access and triage: 12-month follow up of a stepped wedge cluster randomised controlled trial. BMC Health Serv Res 2020; 20:968. [PMID: 33087110 PMCID: PMC7579912 DOI: 10.1186/s12913-020-05824-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 10/15/2020] [Indexed: 11/21/2022] Open
Abstract
Background Timely access is a challenge for providers of outpatient and community-based health services, as seen by the often lengthy waiting lists to manage demand. The Specific Timely Appointments for Triage (STAT) model, an alternative approach for managing access and triage, reduced waiting time by 34% in a stepped wedge cluster randomised controlled trial involving 8 services and more than 3000 participants. Follow up periods ranged from 3 to 10 months across the participating services in accordance with the stepped wedge design. This study aimed to determine whether outcomes were sustained for a full 12 months after implementation of the STAT model at each site. Methods Routinely collected service data were obtained for a total of 12 months following implementation of the STAT model at each of the 8 services that participated in a stepped wedge cluster randomised controlled trial. The primary outcome was time to first appointment. Secondary outcomes included non-attendance rates, time to second appointment and service use over 12 weeks. Outcomes were compared to pre-intervention data from the original trial, modelled using generalised linear mixed effects models accounting for clustering of sites. Results A 29% reduction in waiting time could be attributed to STAT over 12 months, compared to 34% in the original trial. A reduction in variability in waiting time was sustained. There were no significant changes in time to second appointment or in the number of missed appointments in the extended follow up period. Conclusions STAT is an effective strategy for reducing waiting time in community-based outpatient services. At 12 months, small reductions in the overall effect are apparent, but reductions in variability are sustained, suggesting that people who previously waited the longest benefit most from the STAT model. Trial registration This is a 12-month follow up of a stepped wedge cluster randomised controlled trial that was registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12615001016527).
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Affiliation(s)
- Katherine E Harding
- Allied Health Clinical Rsearch Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia. .,La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
| | - David A Snowdon
- Allied Health Clinical Rsearch Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia
| | - Luke Prendergast
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Annie K Lewis
- Allied Health Clinical Rsearch Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia
| | - Bridie Kent
- Drake Circus, Plymouth University, Plymouth, Devon, PL4 8AA, UK
| | - Sandy F Leggat
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Rsearch Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.,La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
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Déry J, Ruiz A, Routhier F, Bélanger V, Côté A, Ait-Kadi D, Gagnon MP, Deslauriers S, Lopes Pecora AT, Redondo E, Allaire AS, Lamontagne ME. A systematic review of patient prioritization tools in non-emergency healthcare services. Syst Rev 2020; 9:227. [PMID: 33023666 PMCID: PMC7541289 DOI: 10.1186/s13643-020-01482-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient prioritization is a strategy used to manage access to healthcare services. Patient prioritization tools (PPT) contribute to supporting the prioritization decision process, and to its transparency and fairness. Patient prioritization tools can take various forms and are highly dependent on the particular context of application. Consequently, the sets of criteria change from one context to another, especially when used in non-emergency settings. This paper systematically synthesizes and analyzes the published evidence concerning the development and challenges related to the validation and implementation of PPTs in non-emergency settings. METHODS We conducted a systematic mixed studies review. We searched evidence in five databases to select articles based on eligibility criteria, and information of included articles was extracted using an extraction grid. The methodological quality of the studies was assessed by using the Mixed Methods Appraisal Tool. The article selection process, data extraction, and quality appraisal were performed by at least two reviewers independently. RESULTS We included 48 studies listing 34 different patient prioritization tools. Most of them are designed for managing access to elective surgeries in hospital settings. Two-thirds of the tools were investigated based on reliability or validity. Inconclusive results were found regarding the impact of PPTs on patient waiting times. Advantages associated with PPT use were found mostly in relationship to acceptability of the tools by clinicians and increased transparency and equity for patients. CONCLUSIONS This review describes the development and validation processes of PPTs used in non-urgent healthcare settings. Despite the large number of PPTs studied, implementation into clinical practice seems to be an open challenge. Based on the findings of this review, recommendations are proposed to develop, validate, and implement such tools in clinical settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018107205.
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Affiliation(s)
- Julien Déry
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Angel Ruiz
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.,Faculty of Business Administration, Université Laval, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Valérie Bélanger
- Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada.,Department of Logistics and Operations Management, HEC Montréal, Montréal, Canada
| | - André Côté
- Faculty of Business Administration, Université Laval, Québec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Centre de recherche en gestion des services de santé, Université Laval, Québec, Canada
| | - Daoud Ait-Kadi
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada.,Department of Mechanical Engineering, Université Laval, Québec, Canada
| | - Marie-Pierre Gagnon
- Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Faculty of Nursing, Université Laval, Québec, Canada
| | - Simon Deslauriers
- Department of Rehabilitation, Université Laval, Québec, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Ana Tereza Lopes Pecora
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Eduardo Redondo
- Faculty of Business Administration, Université Laval, Québec, Canada.,Centre interuniversitaire de recherche sur les réseaux d'entreprise, la logistique et le transport (CIRRELT), Université de Montréal, Montréal, Canada
| | - Anne-Sophie Allaire
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada. .,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada.
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Abstract
PURPOSE The purpose of this paper is to define a clinical pathway for total joint replacement (TJR) surgery, estimate the effect of delays between steps of the pathway on wait time for surgery and to identify factors contributing to more efficient operations and challenges to their implementation. DESIGN/METHODOLOGY/APPROACH This is a case study with a mixed methods approach. The authors conducted interviews with hospital staff. Data collected in the interviews and through on-site observation were analyzed to map the TJR process and identify the steps of the care pathway. The authors extracted and analyzed data (time stamps) from 60 hospital patient records for each step in the pathway and ran a regression on the duration of the whole trajectory. FINDINGS There were wide variations in the delays observed between the seven steps identified. The delay between Step 1 and Step 2 was the only significant variable in predicting the total wait time to surgery. In one hospital, one delay explained 50 percent of the variation. There was misalignment between findings from the qualitative data in terms of strategies implemented to increase efficiency of the clinical pathway to the quantitative data on delays between the steps. RESEARCH LIMITATIONS/IMPLICATIONS The study identified the clinical pathway from the consultation with an orthopaedic surgeon to the surgery. However, it did not go beyond the surgery. Future research could investigate the relationship between specific processes and delays between steps of the process and patient outcomes, including length of stay, mobilization and functionality in activities of daily living, as well as potential complications from surgery, readmission and the services required after the patient was discharged. PRACTICAL IMPLICATIONS Wait times can be addressed by implementing strategies at the health system level or at the organizational level. The authors found and discuss areas where there could be efficiency gains for health care organizations. SOCIAL IMPLICATIONS Stakeholders in care processes are diverse and they each have their preferences in how they practice (in the case of providers) and how they perceive and wish to respond adequately to patients' needs in contexts that have different norms and approaches. The approach in this study enables a better understanding of the processes, the organizational culture and how these may affect each other. ORIGINALITY/VALUE Our mixed methods enabled a process mapping and the identification of factors that significantly affected the efficiency of the TJR surgery process. It combines methods from process engineering with health services and management research. To some extent, this study demonstrates that although managers can define and enforce processes, organizational culture and practices are harder to influence.
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Affiliation(s)
- Maude Laberge
- Department of Operations and Decision Systems, Universite Laval Faculte des sciences de l'administration , Quebec, Canada
| | - André Côté
- Department of Operations and Decision Systems, Universite Laval Faculte des sciences de l'administration , Quebec, Canada
| | - Angel Ruiz
- Department of Operations and Decision Systems, Universite Laval Faculte des sciences de l'administration , Quebec, Canada
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Lewis AK, Taylor NF, Carney PW, Harding KE. Specific timely appointments for triage to reduce wait times in a medical outpatient clinic: protocol of a pre-post study with process evaluation. BMC Health Serv Res 2019; 19:831. [PMID: 31718635 PMCID: PMC6852965 DOI: 10.1186/s12913-019-4660-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Managing demand for services is a problem in many areas of healthcare, including specialist medical outpatient clinics. Some of these clinics have long waiting lists with variation in access for referred people. A model of triage and appointment allocation has been developed and tested that has reduced waiting times by about a third in community outpatient services. This study aims to determine whether the model can be applied in the setting of a specialist medical outpatient clinic to reduce wait time from referral to first appointment. Methods A pre-post study will collect data before and after implementing the Specific Timely Appointments for Triage (STAT) model of access and triage. The study will incorporate a pre-implementation period of 12 months, an implementation period of up to 6 months and a post STAT-implementation period of 6 months. The setting will be the epilepsy clinic at a metropolitan health service in Melbourne. Included will be all people referred to the clinic, or currently waiting, during the allocated periods of data collection (total sample estimated n = 975). Data routinely collected by the health service and qualitative data from staff will be analysed to determine the effects of introducing the STAT model. The primary outcome will be wait time, measured by number of patients on the wait list at monthly time points and the mean number of days waited from referral to first appointment. Secondary outcomes will include patient outcomes, such as admission to hospital while waiting, and service outcomes, including rate of discharge. Analysis of the primary outcome will include interrupted time series analysis and simple comparisons of the pre and post-implementation periods. Process evaluation will include investigation of the fidelity of the intervention, adaptations required and qualitative analysis of the experiences of clinic staff. Discussion Prompt access to service and optimum patient flow is important for patients and service providers. Testing the STAT model in a specialist medical outpatient clinic will add to the evidence informing service providers and policy makers about how the active management of supply and demand in health care can influence wait times. The results from this study may be applicable to other specialist medical outpatient clinics, potentially improving access to care for many people.
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Affiliation(s)
- Annie K Lewis
- Allied Health Clinical Research Office and Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, Victoria, 3128, Australia. .,School of Allied Health, Health Services and Sport, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia.
| | - Nicholas F Taylor
- Allied Health Clinical Research Office and Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, Victoria, 3128, Australia.,School of Allied Health, Health Services and Sport, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
| | - Patrick W Carney
- Allied Health Clinical Research Office and Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, Victoria, 3128, Australia.,Neurosciences, Monash University, 21 Chancellors Walk, Clayton, Victoria, 3800, Australia.,The Florey Institute for Neuroscience and Mental Health, Melbourne Brain Centre, Burgundy Street, 3084, Heidelberg, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office and Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, Victoria, 3128, Australia.,School of Allied Health, Health Services and Sport, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
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Castro Corredor D, Cuadra Díaz JL, Mateos Rodríguez JJ, Anino Fernández J, Mínguez Sánchez MD, de Lara Simón IM, Tébar MÁ, Añó E, Sanz MD, Ballester MN. Self-management model in the scheduling of successive appointments in rheumatology. Reumatol Clin (Engl Ed) 2019; 15:333-337. [PMID: 29325764 DOI: 10.1016/j.reuma.2017.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The rheumatology service of Ciudad Real Hospital, located in an autonomous community of that same name that is nearly in the center of Spain, implemented a self-management model of successive appointments more than 10 years ago. Since then, the physicians of the department schedule follow-up visits for their patients depending on the disease, its course and ancillary tests. The purpose of this study is to evaluate and compare the self-management model for successive appointments in the rheumatology service of Ciudad Real Hospital versus the model of external appointment management implemented in 8 of the hospital's 15 medical services. MATERIAL AND METHODS A comparative and multivariate analysis was performed to identify variables with statistically significant differences, in terms of activity and/or performance indicators and quality perceived by users. The comparison involved the self-management model for successive appointments employed in the rheumatology service of Ciudad Real Hospital and the model for external appointment management used in 8 hospital medical services between January 1 and May 31, 2016. RESULTS In a database with more than 100,000 records of appointments involving the set of services included in the study, the mean waiting time and the numbers of non-appearances and rescheduling of follow-up visits in the rheumatology department were significantly lower than in the other services. The number of individuals treated in outpatient rheumatology services was 7,768, and a total of 280 patients were surveyed (response rate 63.21%). They showed great overall satisfaction, and the incidence rate of claims was low. CONCLUSION Our results show that the self-management model of scheduling appointments has better results in terms of activity indicators and in quality perceived by users, despite the intense activity. Thus, this study could be fundamental for decision making in the management of health care organizations.
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Affiliation(s)
- David Castro Corredor
- Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | - José Luis Cuadra Díaz
- Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | - Joaquín Anino Fernández
- Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | | | - María Ángeles Tébar
- Unidad de Calidad, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Encarnación Añó
- Servicio de Información y Atención al Usuario, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - María Dolores Sanz
- Servicio de Información y Atención al Usuario, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - María Nieves Ballester
- Servicio de Control de Gestión, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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Steen MW, van Vliet C, Festen S, Besselink MG, Gerhards MF, Busch OR. Regional oncology network between pancreatic centers safeguards waiting times for pancreatoduodenectomy. Updates Surg 2019; 71:645-651. [PMID: 31506895 PMCID: PMC6892758 DOI: 10.1007/s13304-019-00677-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/30/2019] [Indexed: 12/18/2022]
Abstract
Pancreatoduodenectomy (PD) is increasingly performed in high-volume centers, which may compromise waiting times. The aim of this study was to evaluate patient flow and outcome of PD within a regional oncology network of two high-volume centers. A post hoc analysis of a partially retrospective and prospective database was performed of all patients who underwent PD for pancreatic or periampullary neoplasms in both centers of the Gastrointestinal Oncology Center Amsterdam, a collaboration between an academic center and affiliated general teaching hospital, from 2010 to 2014. Outcomes included waiting time to surgery and postoperative morbidity and mortality. A total of 525 PDs were performed, 329 in the academic center (annual volume 66) and 196 in the teaching hospital (annual volume 39). Neoadjuvant treatment was more often used in the academic center, other baseline characteristics were similar. Overall time to surgery was 26 days, which was significantly less in the teaching hospital. The major postoperative morbidity rate was 38.3% (n = 201), and the 30- and 90-day mortality was 2.3% and 3.6%. A regional oncology network between an academic center and a general teaching hospital for PD can be an attractive option to safeguard waiting times in selected patients, without compromising outcome.
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Affiliation(s)
- M Willemijn Steen
- Department of Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands. .,Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Claire van Vliet
- Department of Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Sebastiaan Festen
- Department of Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Michael F Gerhards
- Department of Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Zee RA, Clancy AA, Khalil H. Patient attitudes toward pooled surgical waitlists in urogynecology. Int Urogynecol J 2019; 31:311-317. [PMID: 31346655 DOI: 10.1007/s00192-019-04050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/10/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pooled surgical waitlists are used to maximize the use of surgical resources; however, patients' views of this strategy are poorly understood. We sought to evaluate patients' attitudes toward a pooled waitlist for urogynecology and pelvic reconstructive surgical procedures. METHODS Patient and provider focus groups were used to inform the design of a survey that was distributed to patients at the time of consent for female pelvic reconstructive surgical procedures. All responses were collected anonymously. Patient attitudes toward surgical wait times and the potential for a pooled surgical waitlist were explored. Grouped responses by age, procedure type, and perceived disease severity were examined. RESULTS One hundred seventy-six patients were surveyed. Thirty-four percent were amenable to the option of a pooled surgical waitlist; 86% agreed or strongly agreed that they preferred to have their surgery performed by their own care provider. Only 18% would agree to be on a pooled surgical waitlist if it shortened their wait time. Older women (≥ 65 years) were more likely to disagree or strongly disagree that they "would like the option of having surgery done by the next available skilled surgeon" (56.2% vs. 72.0%, p = 0.028). Self-perceived severe disease and mid-urethral sling surgery were not associated with a higher acceptance of pooled surgical waitlists. CONCLUSIONS Acceptance of pooled surgical waitlists among urogynecology patients was overall low, irrespective of disease severity. Improving our understanding of urogynecology patients' concerns and potentially negative perceptions of surgical waitlists is needed to ensure patient comfort and satisfaction are not compromised if this strategy is adopted.
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Affiliation(s)
- Rebekah A Zee
- Division of Urogynecology, Department of Obstetrics and Gynecology, The Ottawa Hospital, 1967 Riverside Dr, Ottawa, ON, K1H 1A2, Canada
| | - Aisling A Clancy
- Division of Urogynecology, Department of Obstetrics and Gynecology, The Ottawa Hospital, 1967 Riverside Dr, Ottawa, ON, K1H 1A2, Canada
| | - Hisham Khalil
- Division of Urogynecology, Department of Obstetrics and Gynecology, The Ottawa Hospital, 1967 Riverside Dr, Ottawa, ON, K1H 1A2, Canada.
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González Coloma F, Sandoval Garcés M, Gedda Quiroga V, Bley Banda C. Teledermatology in Remote Parts of Chile: Experience in 4 Isolated Rural Areas. Actas Dermosifiliogr (Engl Ed) 2019; 110:653-8. [PMID: 31151666 DOI: 10.1016/j.ad.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/13/2019] [Accepted: 01/22/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Teledermatology was introduced in Chile to make up for the lack of dermatologists and improve the primary care system's ability to resolve problems. This strategy was implemented in the province of Palena in 2013, but outcomes were not analyzed and reported until now. MATERIAL AND METHODS Descriptive, cross-sectional study with analysis of inter-rater agreement on diagnoses. All the teledermatology consultations made on behalf of patients in Ayacara, Chaitén, Futaleufú, and Palena from 2013 through 2017 were analyzed. Data were extracted from the MINSAL platform. The κ statistic was used to assess diagnostic agreement. RESULTS A total of 326 teledermatology consultations were made. The mean (SD) age of the patients was 35.8 (22.4) years. The majority (59.8%) were female. Palena generated the largest volume of cases (40.8%). The mean time until a teledermatology diagnosis was given was 12.6 (22.8) days. This response time decreased to 6.4 (5.2) days after a staff dermatologist from Hospital Puerto Montt joined the program (P=.0005). Diagnosis concordance between the general practitioner and the dermatologist was moderate (κ=0.5). Physical examination by the dermatologist at the hospital of reference (Puerto Montt) was necessary for 20.6% of the patients, and time until a definitive diagnosis for the patient took longer in such cases (25.7 [41.2] days) than for the cases that didn't need a physical evaluation at the Hospital of Puerto Montt (P<.0001). CONCLUSIONS Teledermatology provides a necessary diagnostic and therapeutic resource for general practitioners in isolated locations. Diagnostic agreement is moderate between the generalist and the specialist, similar to agreement in international studies but lower than agreement reported in other Chilean studies. The reduction in diagnostic response time after incorporation of a dermatologist on staff at the hospital of Puerto Montt was significant. The significant difference between the time for diagnosis under teledermatology and the delay when physical examination is required at the hospital of Puerto Montt identifies an aspect of care management to improve.
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Malham SA, Smithman MA, Touati N, Brousselle A, Loignon C, Dubois CA, Nour K, Boivin A, Breton M. Explaining variation of implementation outcomes of centralized waiting lists for unattached patients. J Health Organ Manag 2019; 33:563-587. [PMID: 31483206 PMCID: PMC7068727 DOI: 10.1108/jhom-10-2018-0303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Purpose Centralized waiting lists (CWLs) for patient attachment to a primary care provider have been implemented across Canada, including Quebec. Little is known about the implementation of CWLs and the factors that influence implementation outcomes of such primary care innovations. The purpose of this paper is to explain variations in the outcomes of implementation by analyzing the characteristics of CWLs and contextual factors that influence their implementation. Design/methodology/approach A multiple qualitative case study was conducted. Four contrasting CWLs were purposefully selected: two relatively high-performing and two relatively low-performing cases with regard to process indicators. Data collected between 2015 and 2016 drew on three sources: 26 semi-structured interviews with key stakeholders, 22 documents and field notes. The Consolidated Framework for Implementation Research was used to identify, through a cross-case comparison of ratings, constructs that distinguish high from low-performing cases. Findings Five constructs distinguished high from low-performing cases: three related to the inner setting: network and communications; leadership engagement; available resources; one from innovation characteristics: adaptability with regard to registration, evaluation of priority and attachment to a family physician; and, one associated with process domain: engaging. Other constructs exerted influence on implementation (e.g. outer setting, individual characteristics), but did not distinguish high and low-performing cases. Originality/value This is the first in-depth analysis of CWL implementation. Results suggest important factors that might be useful in efforts to continuously improve implementation performance of CWLs and similar innovations.
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Affiliation(s)
| | | | - Nassera Touati
- École nationale d'administration publique, Montréal, Canada
| | - Astrid Brousselle
- School of Public Administration, Université de Sherbrooke - Campus de Longueuil , Longueuil, Canada.,University of Victoria , Victoria, Canada
| | | | - Carl-Ardy Dubois
- Département de gestion, d'évaluation et de politique de santé, Université de Montréal , Montreal, Canada
| | - Kareen Nour
- Centre intégré de sante et de services sociaux de la Montérégie-Centre, Greenfield Park, Canada
| | - Antoine Boivin
- Département de médecine de famille et médecine d'urgence, Faculté de médecine, Université de Montréal , Montreal, Canada
| | - Mylaine Breton
- Université de Sherbrooke - Campus de Longueuil , Longueuil, Canada.,Canadian Research Chair in Clinical Governance on Primary Health Care, Longueuil, Canada
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Harding KE, Snowdon DA, Lewis AK, Leggat SG, Kent B, Watts JJ, Taylor NF. Staff perspectives of a model of access and triage for reducing waiting time in ambulatory services: a qualitative study. BMC Health Serv Res 2019; 19:283. [PMID: 31053118 PMCID: PMC6500050 DOI: 10.1186/s12913-019-4123-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/24/2019] [Indexed: 11/29/2022] Open
Abstract
Background Specific Timely Appointments for Triage (STAT) is an intervention designed to reduce waiting time in community outpatient health services, shown to be effective in a large stepped wedge cluster randomised controlled trial. STAT combines initial strategies to reduce existing wait lists with creation of a specific number of protected appointments for new patients based on demand. It offers an alternative to the more traditional methods of demand management for these services using waiting lists with triage systems. This study aimed to explore perceptions of clinicians and administrative staff involved in implementing the model. Method Semi-structured interviews with 20 staff members who experienced the change to STAT were conducted by an independent interviewer. All eight sites involved in the original trial and all professional disciplines were represented in the sample. Data were coded and analysed thematically. Results Participants agreed that shorter waiting time for patients was the main advantage of the STAT model, and that ongoing management of caseloads was challenging. However, there was variation in the overall weight placed on these factors, and therefore the participants’ preference for the new or previous model of care. Perceptions of whether the advantages outweighed the disadvantages were influenced by five sub-themes: staff perception of how much waiting matters to the patient, prior exposure to the management of waiting list, caseload complexity, approach and attitude to the implementation of STAT and organisational factors. Conclusions The STAT model has clear benefits but also presents challenges for staff members. The findings of this study suggest that careful preparation and management of change and active planning for known fluctuations in supply and demand are likely to help to mitigate sources of stress and improve the likelihood of successful implementation of the STAT model for improving waiting times for patients referred to community outpatient services.
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Affiliation(s)
- Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia. .,La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
| | - David A Snowdon
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.,La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Annie K Lewis
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.,La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Sandra G Leggat
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
| | - Bridie Kent
- Plymouth University, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - Jennifer J Watts
- Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC, 3128, Australia.,La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia
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Saab S, Saggi SS, Akbar M, Choi G. Presumed Consent: A Potential Tool for Countries Experiencing an Organ Donation Crisis. Dig Dis Sci 2019; 64:1346-55. [PMID: 30519849 DOI: 10.1007/s10620-018-5388-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is currently an inadequate supply of allografts to meet the number of transplant candidates worldwide. A number of controversial policies, including implementation of a presumed consent organ donation system, have been considered to rectify the organ donation crisis. AIMS A secondary retrospective data analysis aimed to assess the impact of switching to a presumed consent organ donation model on organ donation rates. METHODS Deceased organ donation rates were compared before and after countries adopted presumed consent. RESULTS Six countries met entry criteria. All six countries had an increase in liver donation rates, while 4 out of the six countries had an increase in kidney donation rates. The overall mean (± SD) liver donation rate was 3.23 (± 0.97) per million population (pmp) before the transition and 6.46 (± 1.81) pmp after the transition (p < 0.0001). The overall mean (± SD) kidney donation rate was 17.94 (± 3.34) pmp before the transition and 26.58 (± 4.23) pmp after the transition (p < 0.0001). The percentage increase in liver and kidney donation rates varied among countries, ranging from 28 to 1186%. CONCLUSION The transition from explicit to presumed consent was associated with a significant increase in liver donation rates in all countries that met our criteria, while the effect on kidney donation rates was partially realized. Although presumed consent alone is unlikely to explain the increase in donation rates, the adoption of such a policy may prove to be a worthwhile risk for countries experiencing consistently low organ donation rates.
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Jeon HJ, Bae HJ, Ham YR, Choi DE, Na KR, Ahn MS, Lee KW. Outcomes of end-stage renal disease patients on the waiting list for deceased donor kidney transplantation: A single-center study. Kidney Res Clin Pract 2019; 38:116-123. [PMID: 30743320 PMCID: PMC6481973 DOI: 10.23876/j.krcp.18.0068] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/08/2018] [Accepted: 11/12/2018] [Indexed: 12/27/2022] Open
Abstract
Background Kidney transplantation is an effective renal replacement therapy for patients with end-stage renal disease (ESRD). In this study, we assessed the impact of the baseline characteristics and comorbidities of ESRD patients on the probability of deceased donor kidney transplantation (DDKT) and evaluated the morbidity and mortality during the time spent waiting. Methods The study population consisted of 544 ESRD patients on the waiting list for DDKT at Chungnam National University Hospital in South Korea between February 2000 and October 2015. The patients were observed from the date of transplantation list registration to the date of transplantation. Baseline characteristics and comorbidities were investigated together with new-onset comorbidities that occurred during the waiting time. Results Diabetes mellitus (39.0%), hypertension (25.2%), and glomerulonephritis (21.3%) were the three most common causes of ESRD in this study, and coronary artery disease (9.4%) was the most common comorbidity. The 115 patients (19.3%) who underwent DDKT had a mean waiting time of 1,711 days (768–2,654 days or 4.68 years [2.10–7.27]). Blood groups other than type O, peritoneal dialysis, and nondiabetic ESRD were significantly associated with a higher likelihood of DDKT. Infection was the leading cause of death and the most common comorbidity that arose during the waiting time. Patients who experienced cardiovascular events during the waiting time showed a lower transplant rate compared with those who did not. Conclusion The prevalence of comorbidities was high in renal transplantation candidates. During the often-long waiting time, new comorbidities may occur, with long-term sequelae limiting access to kidney transplantation or resulting in death.
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Affiliation(s)
- Hong Jae Jeon
- Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hong Jin Bae
- Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Young Rok Ham
- Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Dae Eun Choi
- Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Ki Ryang Na
- Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Moon-Sang Ahn
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Kang Wook Lee
- Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
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Déry J, Ruiz A, Routhier F, Gagnon MP, Côté A, Ait-Kadi D, Bélanger V, Deslauriers S, Lamontagne ME. Patient prioritization tools and their effectiveness in non-emergency healthcare services: a systematic review protocol. Syst Rev 2019; 8:78. [PMID: 30927927 PMCID: PMC6441215 DOI: 10.1186/s13643-019-0992-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/19/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Waiting lists should be managed as fairly as possible to ensure that patients with greater or more urgent needs receive services first. Patient prioritization refers to the process of ranking referrals in a certain order based on various criteria with the aim of improving fairness and equity in the delivery of care. Despite the widespread use of patient prioritization tools (PPTs) in healthcare services, the existing literature on this subject has mainly focused on emergency settings. Evidence has not been synthesized with respect to all the non-emergency services. METHODS This review aims to perform a systematic synthesis of published evidence concerning (1) prioritization tools' characteristics, (2) their metrological properties, and (3) their effect measures across non-emergency services. Five electronic databases will be searched (Cochrane Library, Ovid/MEDLINE, Embase, Web of Science, and CINAHL). Eligibility criteria guiding data selection will be (1) qualitative, quantitative, or mixed methods empirical studies; (2) patient prioritization in any non-emergency setting; and (3) discussing characteristic, metrological properties, or effect measures. Data will be sought to report tool's format, description, population, setting, purpose, criteria, developer, metrological properties, and outcome measures. Two reviewers will independently screen, select, and extract data. Data will be synthesized with sequential exploratory design method. We will use the Mixed Methods Appraisal Tool (MMAT) to assess the quality of articles included in the review. DISCUSSION This systematic review will provide much-needed knowledge regarding patient prioritization tools. The results will benefit clinicians, decision-makers, and researchers by giving them a better understanding of the methods used to prioritize patients in clinical settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018107205.
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Affiliation(s)
- Julien Déry
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Angel Ruiz
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
- Faculty of Business Administration, Université Laval, Québec, Canada
- Centre interuniversitaire de recherche sur les réseaux d’entreprise, la logistique et le transport (CIRRELT), Montréal, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Québec, Canada
- Centre de recherche du CHU de Québec, Québec, Canada
| | - André Côté
- Faculty of Business Administration, Université Laval, Québec, Canada
- Centre de recherche du CHU de Québec, Québec, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, Canada
| | - Daoud Ait-Kadi
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
- Centre interuniversitaire de recherche sur les réseaux d’entreprise, la logistique et le transport (CIRRELT), Montréal, Canada
- Department of Mechanical Engineering, Université Laval, Québec, Canada
| | - Valérie Bélanger
- Centre interuniversitaire de recherche sur les réseaux d’entreprise, la logistique et le transport (CIRRELT), Montréal, Canada
- Department of Logistics and Operations Management, HEC Montréal, Montréal, Canada
| | - Simon Deslauriers
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Centre Intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
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Martinez DA, Zhang H, Bastias M, Feijoo F, Hinson J, Martinez R, Dunstan J, Levin S, Prieto D. Prolonged wait time is associated with increased mortality for Chilean waiting list patients with non-prioritized conditions. BMC Public Health 2019; 19:233. [PMID: 30808318 PMCID: PMC6390314 DOI: 10.1186/s12889-019-6526-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/08/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Most data on mortality and prognostic factors of universal healthcare waiting lists come from North America, Australasia, and Europe, with little information from South America. We aimed to determine the relationship between medical center-specific waiting time and waiting list mortality in Chile. METHOD Using data from all new patients listed in medical specialist waitlists for non-prioritized health problems from 2008 to 2015 in three geographically distant regions of Chile, we constructed hierarchical multivariate survival models to predict mortality risk at two years after registration for each medical center. Kendall rank correlation analysis was used to measure the association between medical center-specific mortality hazard ratio and waiting times. RESULT There were 987,497 patients waiting for care at 77 medical centers, including 33,546 (3.40%) who died within two years after registration. Male gender (hazard ratio [HR] = 1.17, 95% confidence interval [CI] 1.1-1.24), older age (HR = 2.88, 95% CI 2.72-3.05), urban residence (HR = 1.19, 95% CI 1.09-1.31), tertiary care (HR = 2.2, 95% CI 2.14-2.26), oncology (HR = 3.57, 95% CI 3.4-3.76), and hematology (HR = 1.6, 95% CI 1.49-1.73) were associated with higher risk of mortality at each medical center with large region-to-region variations. There was a statistically significant association between waiting time variability and death (Z = 2.16, P = 0.0308). CONCLUSION Patient wait time for non-prioritized health conditions was associated with increased mortality in Chilean hospitals.
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Affiliation(s)
- Diego A. Martinez
- Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Haoxiang Zhang
- Johns Hopkins University Whiting School of Engineering, 3400 N Charles St, Baltimore, MD 21218 USA
| | - Magdalena Bastias
- University of Chile School of Public Health, Av. Independencia 939, Independencia, Región Metropolitana Chile
| | - Felipe Feijoo
- Pontifical Catholic University of Valparaíso School of Engineering, Brasil, 2950 Valparaíso, Región de Valparaíso Chile
| | - Jeremiah Hinson
- Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Rodrigo Martinez
- University of Chile School of Public Health, Av. Independencia 939, Independencia, Región Metropolitana Chile
| | - Jocelyn Dunstan
- University of Chile School of Public Health, Av. Independencia 939, Independencia, Región Metropolitana Chile
| | - Scott Levin
- Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 USA
| | - Diana Prieto
- Johns Hopkins University Carey School of Business, 100 International Drive, Baltimore, MD 21202 USA
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Smithman MA, Brousselle A, Touati N, Boivin A, Nour K, Dubois CA, Loignon C, Berbiche D, Breton M. Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada. Int J Equity Health 2018; 17:176. [PMID: 30509274 PMCID: PMC6277998 DOI: 10.1186/s12939-018-0887-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists. METHODS A cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients' socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs. RESULTS Patients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas. CONCLUSION Our findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities.
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Affiliation(s)
- Mélanie Ann Smithman
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, 3800 Finnerty Rd, Suite A302, Victoria, British Columbia, V8P 5C2, Canada
| | - Nassera Touati
- Centre de recherche sur la gouvernance, École nationale d'administration publique, 4750, Avenue Henri-Julien, Office 5117, Montreal, Quebec, H2T 3E5, Canada
| | - Antoine Boivin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, 900 Rue Saint-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Kareen Nour
- Direction de santé publique, Centre intégré de santé et des services sociaux - Montérégie-Centre, 1255 rue Beauregard, Longueuil, Quebec, J4K 2M3, Canada
| | - Carl-Ardy Dubois
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte Ste-Catherine, Office 5103, Montreal, Quebec, H3T 1A8, Canada
| | - Christine Loignon
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Djamal Berbiche
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Mylaine Breton
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada.
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Abstract
The number of organ donors in Germany has been falling since 2010. In 2017, it reached its lowest level in 20 years with 797 organ donors. With 9.7 organ donors per million inhabitants, Germany lags far behind other European countries. The development of the donor numbers has long been an issue of concern for the Deutsche Stiftung Organtransplantation (DSO). Together with the donor hospitals, DSO has carried out extensive analyses on the possible causes. Though causes are multiple and complex, one important lever for improving the situation is seen in better detection and consistent reporting of possible organ donors. This is considered the best way to meet the patient's desire regarding organ donation. With reference to the dramatic development, DSO calls for a broad social debate and a joint initiative involving medical associations, contractors, patient associations and policymakers. Getting organ donation back on track in Germany for the benefit of patients on the waiting lists can only be achieved by a joint effort.
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Affiliation(s)
- A Rahmel
- Deutsche Stiftung Organtransplantation, Deutschherrnufer 52, 60594, Frankfurt am Main, Deutschland.
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Lewis AK, Harding KE, Snowdon DA, Taylor NF. Reducing wait time from referral to first visit for community outpatient services may contribute to better health outcomes: a systematic review. BMC Health Serv Res 2018; 18:869. [PMID: 30458761 PMCID: PMC6245820 DOI: 10.1186/s12913-018-3669-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many people wait long periods for community outpatient services. However little is known about the impact of waiting from referral to first visit on patient outcomes. The aim of this systematic review is to investigate whether waiting for community outpatient services is associated with adverse effects on patient outcomes. METHODS Medline, Embase, Psych Info and CINAHL databases were searched, combining the key concepts of waiting for healthcare and patient outcomes. Studies were included if they reported data comparing health outcomes for patients with different waiting times for the same period. Three reviewers applied inclusion and exclusion criteria to identified studies and assessed quality using the McMaster Critical Review Forms. Levels of evidence were assessed using National Health and Medical Research Council guidelines. Included studies were analysed using a descriptive synthesis, and summarised according to levels of evidence and clinical significance for key outcomes. RESULTS Fourteen studies that included 69,606 adult patients were selected. Selected studies included patients referred for treatment for musculoskeletal disorders (n = 28,722) or to cardiac rehabilitation (n = 40,884). There was low-level evidence that reduced wait time is associated with moderate improvement in workplace participation for patients seeking care for musculoskeletal conditions; and moderate improvement in exercise tolerance for patients referred to cardiac rehabilitation. There was inconsistent evidence that improvements in quality of life, patient satisfaction and psychological symptoms may be associated with shorter wait times. Pain, function and physical activity outcomes were not associated with wait time. CONCLUSIONS This review found low-level evidence suggesting an association between early access to community outpatient services and improvement of some patient outcomes. Specifically, shorter wait times from referral to first visit for musculoskeletal pain services may improve patient work participation. Shorter wait times for cardiac rehabilitation may improve patient exercise capacity. The effects of a short wait time for other patient conditions and patient outcomes, including quality of life, psychological symptoms and patient experience, are inconclusive. The modest benefits in health outcomes observed in reducing wait time for community outpatient services suggest that other possible benefits such as increasing patient flow should be explored. TRIAL REGISTRATION PROSPERO registration no: CRD42016047003.
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Affiliation(s)
- Annie K. Lewis
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC 3128 Australia
- La Trobe University, Bundoora, VIC 3086 Australia
| | - Katherine E. Harding
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC 3128 Australia
- La Trobe University, Bundoora, VIC 3086 Australia
| | - David A. Snowdon
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC 3128 Australia
- La Trobe University, Bundoora, VIC 3086 Australia
| | - Nicholas F. Taylor
- Allied Health Clinical Research Office, Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC 3128 Australia
- La Trobe University, Bundoora, VIC 3086 Australia
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da Fonseca VBP, De Lorenzo A, Tura BR, Pittella FJM, da Rocha ASC. Mortality and morbidity of patients on the waiting list for coronary artery bypass graft surgery. Interact Cardiovasc Thorac Surg 2018; 26:34-40. [PMID: 29049704 DOI: 10.1093/icvts/ivx276] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/20/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The public health care system in Brazil has extensive waiting lists of patients requiring complex operations such as coronary artery bypass grafting (CABG). The purpose of this study was to identify the mortality and morbidity rates of the patients awaiting CABG and identify predictors of adverse events and their association with perioperative outcomes. METHODS We conducted a retrospective analysis of outpatient medical records of patients referred for this elective procedure in Rio de Janeiro, Brazil. Excluded from the study were records of patients with any of the following: an indication for urgent surgery, unstable angina or concomitant surgical valvular disease or subsequent transfer to clinical or percutaneous therapy. RESULTS A total of 274 patients were identified and met the inclusion criteria, with a median waiting time for an operation of 142.7 days. While waiting for CABG surgery, 31 (11.3%) patients died of any cause and 42 (15.3%) patients had a serious cardiac event (death, myocardial infarction or unstable angina). Of the 22 (8%) incidents of acute myocardial infarction, 8 (2.9%) were non-fatal and 14 (5.1%) were fatal. There was a greater risk of death awaiting CABG surgery in patients with a left ventricular ejection fraction below 45% (hazard ratio = 2.33, 95% confidence interval 1.02-5.32; P = 0.039). The operative mortality rate was 5.8%. Although there was no evidence of worse perioperative outcomes in patients with prolonged waiting times for an operation, there was an association between waiting more than 16 weeks for an operation and death while on the list. CONCLUSIONS Extensive waiting periods for CABG contribute to higher mortality and morbidity rates, especially in patients with left ventricular dysfunction.
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Affiliation(s)
| | - Andrea De Lorenzo
- Division of Education and Research, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, Brazil
| | - Bernardo Rangel Tura
- Division of Education and Research, Instituto Nacional de Cardiologia (INC), Rio de Janeiro, Brazil
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