Approaches and Challenges To Reducing Wait Times For Total Hip and Knee Replacement

Aileen M. Davis¹, Cheryl Cott², Rose Wong³, Michel Landry⁴, Linda C. Li⁵, Allyson Jones⁶, Cy Frank⁷, Sydney C. Lineker⁸, Louise Bergeron⁹, Rhona McGlasson¹⁰, Gillian A. Hawker¹¹, Dianne P. Mosher¹², Susan B. Jaglal¹³, Richard Birtwhistle¹⁴, Sherry Bar¹⁵ and Elizabeth M. Badley¹⁶, ¹Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Ontario, ON, Canada, ²Divison of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada, ³Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada, ⁴Department of Community and Family Medicine, Physical Therapy Division, Duke University Medical Center, Durham, NC, ⁵Physical Therapy, Arthritis Centre of Canada, Richmond, BC, Canada, ⁶Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada, ⁷Alberta Bone and Joint Institute and Department of Surgery, University of Calgary, Calgary, AB, Canada, ⁸The Arthritis Society, Toronto, ON, Canada, ⁹Canadian Arthritis Patient Alliance, Ottawa, ON, Canada, ¹⁰Bone and Joint Canada, Toronto, ON, Canada, ¹¹Women's College Research Institute, University of Toronto, Toronto, ON, Canada, ¹²Med, University of Calgary, Calgary, AB, Canada, ¹³Department of Physical Therapy, Department of Physical Therapy, University of Toronto, Toronto, ON, Canada, ¹⁴Centre for Studies in Primary Care and Family Medicine and Community Health and Epidemiology, Queen's University, Kingston, ON, Canada, ¹⁵British Columbia Ministry of Health Services, Victoria, BC, Canada, ¹⁶Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Hip and Knee

Session Information

Title: Health Services Research, Quality Measures and Quality of Care - Innovations in Health Care Delivery

Session Type: Abstract Submissions (ACR)

Background/Purpose: Due to obesity, the growing prevalence of hip and knee osteoarthritis and boarder indications for hip and knee replacement, there is increasing pressure on developed countries to provide total joint replacement (TJR) in a timely manner. In Canada, reduction of wait times for TJR was a priority in the 2004 Health Accord (at that time it was not uncommon for waits to exceed 100 weeks) and, as a result, provinces instituted various strategies to reduce the wait. This work describes the approach taken by three provinces to achieve a target 26 week wait from patient/surgeon decision for surgery to surgery for 90% of people.

Methods: This research used a policy case study approach with review of government documents, non-governmental organization reports and published literature for Federal and Provincial policy and descriptions of programs/models of care related to TJR implemented by British Columbia (BC), Alberta (AB) and Ontario (ON). Additionally, one-on-one interviews (n=28) were conducted with policy makers, individuals in key leadership roles, program directors and managers to further understand provincial approaches. Transcribed interviews were analyzed thematically for activities targeted at reducing TJR wait times conducted within each province.

Results: Arthritis prevalence (15-16% over age 15) and health human resources (4 orthopaedic surgeons per 100,000 population) were similar across provinces with each challenged to provide service in low density regions. Although all provinces implemented efficiencies through standardized care pathways and processes to improve operating room access, there were different approaches relating to access to surgical consultation (e.g. referral central intake, triage and who conducted it based on availability, scope of practice, and how programs/providers were funded). AB focused on a case manager who also aided the patient in system navigation; ON focused on rehabilitation professionals working in advanced practice roles for triage; and, BC implemented a variety of approaches, driven by local champions and context. A provincial platform to drive change was critical for success, as were evidence-informed experts who had the authority to make decisions and champion change, and financial resources to support change, program implementation and sustainability. All provinces decreased wait times but, as shown in table 1 (fourth quarter data from fiscal 2012/13), at a provincial level and in the majority of institutions, challenges continue in meeting target wait times.

	Province	Number of primary joint replacements	Wait time (number of weeks for 90%)	Hospitals meeting target	Trend 2010 to 2013
Knee	BC	1255	32.8	12/29	–
	AB	1599	39.1	5/13	+
	ON	8903*	33.1	24/56	+
Hip	BC	1833	37.5	14/29	–
	AB	971	38.9	6/13	+
	ON	–	27.1	33/56	NA

*combined hip and knee

Conclusion: Although sharing common elements in approach, provincial TJR wait time strategies were variable. Despite reductions results have varied across the provinces. This raises questions of whether benchmarks are attainable and how such strategies will be sustained in times of fiscal constraint and rising demand for TJR.

Disclosure:

A. M. Davis,
None;

C. Cott,
None;

R. Wong,
None;

M. Landry,
None;

L. C. Li,
None;

A. Jones,
None;

C. Frank,
None;

S. C. Lineker,
None;

L. Bergeron,
None;

R. McGlasson,
None;

G. A. Hawker,
None;

D. P. Mosher,
None;

S. B. Jaglal,
None;

R. Birtwhistle,
None;

S. Bar,
None;

E. M. Badley,
None.

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