Developing a universal tool for the prioritization of patients waiting for elective surgery

• Published in: Health policy (Amsterdam) Vol. 113; no. 1; pp. 118 - 126
• Main Authors: Solans-Domènech, Maite, Adam, Paula, Tebé, Cristian, Espallargues, Mireia
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.11.2013; Elsevier
• Subjects: Activities of daily living; Benefits; Biological and medical sciences; Canada; Caregivers; Diseases; Elective surgery; Elective Surgical Procedures; Employment; Female; Health administration; Health policy; Health Priorities; Health Services Needs and Demand; Humans; Internal Medicine; Male; Medical sciences; Miscellaneous; Multidisciplinary participation; New Zealand; Patient Selection; Patients; Priorities; Priority-setting; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative techniques; Risk Factors; Severity; Severity of Illness Index; Spain; Success; Surgery; Symptoms; Waiting Lists; Spain; New Zealand; Canada; Spain, Catalonia; Qualitative techniques; Priority-setting; Multidisciplinary participation; Waiting lists; Elective surgery; Human; Participation; Priority; Patient; Priority assignment; Treatment; Criterion; Surgery; Waiting list; Technique; Expectation; Multidisciplinary; Tool
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2013.07.006

Abstract The objective was to elaborate a priority scoring system for patients on waiting lists for elective surgery to be implemented in the Catalan public health system. This tool should ideally be universal (for all patients and across the entire region) with common criteria and weights (for all surgical procedures), simple and user-friendly. A tool based on a point-count linear scale ranging from 0 (lowest priority) to 100 (highest priority) was developed. Patients are scored in three major dimensions: clinical and functional impairment, expected benefit, and social role, which include 8 criteria (with their weights): disease severity (23%), pain (or other main symptoms) (14%), rate of disease progression (15%), difficulty in doing activities of daily life (14%), probability and degree of improvement (12%), being dependent with no caregiver (5%), limitation to care for one's dependents (if that be the case) (8%), and limitations in the ability to work, study or seek for employment (9%). As in previous studies developed in Canada, New Zealand and Catalonia, the tool obtained is mainly based on severity and need. The success of this tool depends very much on implementation mechanisms. Furthermore, prior to implementation, a definition of specificities in the selected criteria for the most frequent surgical procedures is advised.