Premium
The Western Canada Waiting List Project: development of a priority referral score for hip and knee arthroplasty
Author(s) -
De Coster Carolyn,
McMillan Stewart,
Brant Rollin,
McGurran John,
Noseworthy Tom
Publication year - 2007
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2006.00671.x
Subject(s) - medicine , referral , waiting list , knee replacement , intraclass correlation , arthroplasty , physical therapy , prioritization , test (biology) , medline , hip replacement , health care , family medicine , surgery , psychometrics , clinical psychology , paleontology , management science , political science , transplantation , law , economics , biology , economic growth
Abstract Background Recognizing the concerns about long waiting times to see some specialists in Canada, and the burden this places on both primary care and specialist clinicians, the Western Canada Waiting List (WCWL) undertook the Primary Care Project. The goal was to develop a valid, reliable, standardized prioritization tool for use by primary care providers in making referrals to specialists. WCWL is a 20‐partner collaboration committed to addressing long waiting times to access scheduled health care services. Methods A previously developed prioritization tool for hip and knee replacement was adapted for use by family doctors, based on expert feedback from a clinical panel of primary care providers and from orthopaedic surgeons. Rater assessments of standardized paper cases were used to generate weights for criteria items in the Priority Referral Score (PRS). Intraclass correlations (ICCs) were calculated to assess reproducibility, and weights were estimated using a mixed‐effects model. The weights and criteria items were modified following feedback of these results to the panel. The resulting PRS was reliability‐tested with a different set of standardized case descriptions. Results One item was removed from the Hip and Knee Surgery tool and two items more pertinent to family medicine (mobility and medications) were added. The resulting eight‐item PRS had a test–retest ICC of 0.84. The mean intrarater ICC was 0.79. Conclusions An eight‐item priority‐setting tool has been developed to assist in queuing patients in order of urgency when they are referred to an orthopaedic surgeon for possible hip or knee arthroplasty. The tool had excellent inter‐ and intrarater reliability and was seen to have face validity by a panel of primary care providers who advised on the project.