Intended and unintended consequences of strategies to meet performance benchmarks for rheumatologist referrals in a centralized intake system.

Autor: Marshall DA; McCaig Bone and Joint Health Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.; Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Tagimacruz T; Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Barber CEH; McCaig Bone and Joint Health Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.; Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.; Canada Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada.; Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Cepoiu-Martin M; McCaig Bone and Joint Health Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada., Lopatina E; McCaig Bone and Joint Health Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.; Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Robert J; Surgery and Bone & Joint Strategic Clinical Network™, Alberta Health Services, Edmonton, Alberta, Canada., Lupton T; Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Patel J; Strategic Clinical Network™, Alberta Health Services, Edmonton, Alberta, Canada., Mosher DP; Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Jazyk: angličtina
Zdroj: Journal of evaluation in clinical practice [J Eval Clin Pract] 2024 Mar; Vol. 30 (2), pp. 199-208. Date of Electronic Publication: 2023 Sep 18.
DOI: 10.1111/jep.13926
Abstrakt: Rationale: Timely assessment of a chronic condition is critical to prevent long-term irreversible consequences. Patients with inflammatory arthritis (IA) symptoms require diagnosis by a rheumatologist and intervention initiation to minimize potential joint damage. With limited rheumatologist capacity, meeting urgency wait time benchmarks can be challenging. We investigate the impact of the maximum wait time guarantee (MWTG) policy and referral volume changes in a rheumatology central intake (CI) system on meeting this challenge.
Methods: We applied a system simulation approach to model a high-volume CI rheumatology clinic. Model parameters were based on the referral and triage data from the CI and clinic appointment data. We compare the wait time performance of the current distribution policy MWTG and when referral volumes change.
Results: The MWTG policy ensures 100% of new patients see a rheumatologist within their urgency wait time benchmark. However, the average wait time for new patients increased by 51% (178-269 days). A 10% decrease in referrals resulted in a 76% decrease on average wait times (178-43 days) for new patients and an increase in the number of patients seen by a rheumatologist within 1 year of the initial visit.
Conclusion: An MWTG policy can result in intended and unintended consequences-ensuring that all patients meet the wait time benchmarks but increasing wait times overall. Relatively small changes in referral volume significantly impact wait times. These relationships can assist clinic managers and policymakers decide on the best approach to manage referrals for better system performance.
(© 2023 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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