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. 2004 Jun;47(3):173-8.

Monitoring trends in waiting periods in Canada for elective surgery: validation of a method using administrative data

Samuel E D Shortt  1 , Ralph A Shaw, David Elliott, William J Mackillop
Affiliations

Monitoring trends in waiting periods in Canada for elective surgery: validation of a method using administrative data

Samuel E D Shortt et al. Can J Surg. 2004 Jun.

Abstract
in English, French

Background: Provincial governments require timely, economical methods to monitor surgical waiting periods. Although use of prospective procedure-specific registers would be the ideal method, a less elaborate system has been proposed that is based on physician billing data. This study assessed the validity of using the date of the last service billed prior to surgery as a proxy for the beginning of the post-referral, pre-surgical waiting period.

Method: We examined charts for 31,824 elective surgical encounters between 1992 and 1996 at an Ontario teaching hospital. The date of the last service before surgery (the last billing date) was compared with the date of the consultant's letter indicating a decision to book surgery (i.e., to begin waiting).

Results: Several surgical specialties (but excluding cardiac, orthopedic and gynecologic) had a close correlation between the dates of the last pre-surgery visit and those of the actual decision to place the patient on the waiting list. Similar results were found for 12 of 15 individually studied procedures, including some orthopedic and gynecological procedures.

Conclusion: Used judiciously, billing data is a timely, inexpensive and generally accurate method by which provincial governments could monitor trends in waiting times for appropriately selected surgical procedures.

Contexte: Les gouvernements provinciaux ont besoin de moyens pratiques et économiques pour surveiller les périodes d'attente en chirurgie. Même si des registres prospectifs particuliers à une intervention constitueraient la méthode idéale, on a proposé un système moins complexe fondé sur les données de facturation des médecins. Au cours de cette étude, les chercheurs ont évalué la validité de l'utilisation du dernier acte facturé avant l'intervention chirurgicale pour représenter le début de la période d'attente après la référence et avant l'intervention.

Méthode: Nous avons étudié les dossiers de 31 824 consultations pour chirurgie élective entre 1992 et 1996 à un hôpital universitaire de l'Ontario. On a comparé la date du dernier acte avant l'intervention chirurgicale (la dernière date de facturation) à celle de la lettre du médecin-conseil indiquant que l'on avait décidé de réserver une intervention chirurgicale (c.-à-d. de commencer à attendre).

Résultats: Dans plusieurs spécialités en chirurgie (sauf toutefois la cardiologie, l'orthopédie et la gynécologie), on a établi un lien direct entre la dernière consultation avant l'intervention chirurgicale et la décision d'inscrire le patient sur la liste d'attente. L'étude individuelle de 12 interventions sur 15, y compris certaines interventions en orthopédie et en gynécologie, a produit des résultats semblables.

Conclusion: Utilisées judicieusement, les données de facturation constituent un moyen pratique, peu coûteux et généralement précis qui permettrait aux gouvernements provinciaux de suivre les tendances des temps d'attente pour certaines interventions chirurgicales soigneusement sélectionnées.

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Figures

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FIG. 1. Waiting times: cumulative percentage.
See this image and copyright information in PMC

Comment in

References

    1. Canadian Medical Association. Canadians say health care worse today than a year ago [news release]. 1997 Apr 29.
    1. Ontario College of Family Physicians. CFPC headlines. Chapter 1998;10:2. Toronto: the College; 1998.
    1. Ramsay C, Walker M. Waiting your turn: hospital waiting lists in Canada. 8th ed. Vancouver: Fraser Institute Critical Issues Bulletin; 1998.
    1. Nova Scotia Department of Health. Reporting health performance, elective procedure waiting times in Nova Scotia, 1992-1996. Halifax: the Department; 1996. p. 1-64.
    1. British Columbia Ministry of Health and Ministry Responsible for Seniors. Waiting list report. Victoria: the Ministry; 1997. p. 1-23.

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