A single-entry model and wait time for hip and knee replacement in eastern health region of Newfoundland and Labrador 2011-2019

• Published in: BMC health services research Vol. 22; no. 1; p. 82
• Main Authors: Vo, Anh Thu, Yi, Yanqing, Mathews, Maria, Valcour, James, Alexander, Michelle, Billard, Marcel
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.01.2022; BioMed Central; BMC
• Subjects: Age groups; Aged; Annual reports; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Benchmarks; Consultation; Data analysis; Health services; Hospitals; Humans; Joint replacement surgery; Knee; Management; Medical referrals; Newfoundland and Labrador; Orthopedic surgery; Orthopedics; Pathology; Patients; Priority levels; Referral and Consultation; Single-entry model; Surgeons; Surgery; Survival analysis; Total knee replacement; Wait time; Waiting Lists; Newfoundland and Labrador; Canada; Newfoundland & Labrador Canada; Priority levels; Survival analysis; Total knee replacement; Wait time; Surgery; Consultation; Single-entry model; Total hip replacement
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-021-07451-8

A single-entry model in healthcare consolidates waiting lists through a central intake and allows patients to see the next available health care provider based on the prioritization. This study aimed to examine whether and to what extent the prioritization reduced wait times for hip and knee replacement surgeries. The survival regression method was used to estimate the effects of priority levels on wait times for consultation and surgery for hip and knee replacements. The sample data included patients who were referred to the Orthopedic Central Intake clinic at the Eastern Health region of Newfoundland and Labrador and had surgery of hip and knee replacements between 2011 and 2019. After adjusting for covariates, the hazard of having consultation booked was greater in patients with priority 1 and 2 than those in priority 3 when and at 90 days after the referral was made for both hip and knee replacements. Regarding wait time for surgery after the decision for surgery was made, while the hazard of having surgery was lower in priority 2 than in priority 3 when and indifferent at 182 days after the decision was made, it was not significantly different between priority 1 and priority 3 among hip replacement patients. Priority levels were not significantly related to the hazard of having surgery for a knee replacement after the decision for surgery was made. Overall, the hazard of having surgery after the referral was made by a primary care physician was greater for patients in high priority than those in low priority. Preferring a specific surgeon indicated at referral was found to delay consultation and it was not significantly related to the total wait time for surgery. Incomplete referral forms prolonged wait time for consultation and patients under age 65 had a longer total wait time than those aged 65 or above. Patients with high priority could have a consultation booked earlier than those with low priority and prioritization in a single entrance model shortens the total wait time for surgery. However, the association between priority levels and wait for surgery after the decision for surgery was made has not well-established.