Wait times in hip and knee replacement: single-entry model and prioritization

Vo, Anh Thu Thi (2021) Wait times in hip and knee replacement: single-entry model and prioritization. Masters thesis, Memorial University of Newfoundland.

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Abstract

The single-entry model (SEM) in healthcare consolidates waiting lists through a single point-of-entry and patients can see the next available surgeon from a pooled available provider based on the patient’s urgent levels. Prioritization is used to ensure that patients with higher urgent levels may access care quickly. The SEM for hip and knee replacement surgery in the Eastern Health region of Newfoundland and Labrador showed a reduction in wait times for consultation by priority levels. Little is known about the improvement in wait times for surgery and the chance of receiving consultation and surgery within the national benchmarks by priority levels. This study aimed to examine the SEM’s role in timely access to orthopedic services and evaluate an association between factors and receiving consultation and surgery within the national benchmarks through the SEM. Survival analysis was conducted to estimate wait times, examine factors impacting wait times for hip and knee replacement. The data used were adult patients referred to the Orthopedic Central Intake clinic in the Eastern Health region for a total hip or knee arthroplasty assessment between 2011-2019. Logistic regression analysis was used to explore the association between these factors and the receiving consultation and surgery within benchmarks. The study revealed that hip or knee replacement patients with high urgent had more likely to see an orthopedic surgeon for consultation than those with low urgent. Hip or knee replacement patients with priority 1 were more likely to have a consultation within 90 days than their counterparts. Priority levels were not significantly related to the likelihood of having surgery since the decision to surgery was made for both hip and knee. The likelihood of receiving a knee replacement surgery within 182 days was nonsignificant among patients with priority 1, priority 2, and priority 3, while hip replacement patients with priority 3 were more likely to have surgery within 182 days than those with a high priority level. Choosing the next available surgeon shortened wait times for consultation and improved the likelihood of receiving consultation within 90 days. However, this choice was less likely to have surgery within 182 days than choosing a specific surgeon. Incomplete initial referral forms prolonged wait times for consultation but insignificantly impacted the probability of having consultation within 90 days. Patients with knee osteoarthritis were less likely to have consultations within 90 days than patients with other arthritis disorders. This study explored the timely improvement of access to consultation for hip and knee replacement by priority levels and factors impacting wait times through the SEM. An association between wait time for surgery and priority levels was not found in this study, whereas hip replacement patients with low priority were more likely to receive surgery within the benchmark of 182 days than those with high priority. Further studies are needed to investigate this.

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