In health care systems that provide universal access to care, efforts to contain costs for standby hospital capacity usually result in wait lists for surgical procedures. When access to health care is rationed by such wait lists, the length of time that patients are required to wait is usually uncertain. This uncertainty is a natural product of stochastic variation in service time and in the percentage of urgent cases in any queuing system. However, in a queue for elective (nonemergency) procedures, waiting-time uncertainty has many additionalcauses. Forinstance,decisionsofbothpatientsandcareprovidersmayoverrideaqueuediscipline. Alternatively, the lack of a hospital resource, such as beds in the intensive care unit, may change queuing practices in favor of services that would not require the resource. Waiting time is often compared between regions, hospitals, periods, or surgical services to evaluate p- icy and performance. However, surprisingly little attention has been given to the variation in times spent in a single queue. Why some patients wait longer than others remains an important question in health services - search. Itisunclear,forexample, whether timetoservicevariesmorethanwouldbeexpected throughchance alone after differences in clinical condition are taken into account. Another important issue is preferential allocation of hospital resources. It also remains unclear whether patients of low priority are admitted directly as a way to circumvent long wait lists or to substitute for cancellations on the operating room schedule.
Analysis from health services research perspective, rather than operations management
Contains a collection of examples of waiting-time data analysis in health services research
Analysis of Waiting-Time Data in Health Services Research
By Boris Sobolev, University of British Columbia, and Lisa Kuramoto, Vancouver Coastal Health Research Institute
Access to care, patient flow, treatment outcomes—each of these indicators is crucial to determining quality of care in health systems, and the length of time that patients wait for surgery unites them all. Presenting a detailed set of statistical concepts and methods, Analysis of Waiting-Time Data in Health Services Research asks critical questions linking waiting times to health care outcomes. Generously illustrated with charts and tables, the book places this type of data collection, analysis, and reporting firmly in the context of health services research, the study of outcomes of health care delivery to a population.
Some of the questions investigated in this volume include:
- What factors are associated with longer waiting times?
- What is the probability of undergoing elective surgery within the recommended time?
- How does the type of procedure affect waiting time?
- What are the effects of delays in scheduling an operation?
- What is the risk of unplanned emergency surgery among patients waiting for surgery?
- What is the risk of death associated with delayed surgical treatment?
The authors use Canadian data on time to elective coronary artery bypass grafting, vascular surgery, and cholecystectomy to arrive at potent answers. This in-depth analysis offers researchers and advanced students in health services research an invaluable framework for studying access to care both within and across institutions. At the same time, the book serves as a practical resource for administrators and policymakers seeking to improve access and effectiveness at their hospitals.
Dr. Sobolev and Ms. Kuramoto are based at the Centre of Clinical Epidemiology and Evaluation of the Vancouver Coastal Health Research Institute.
Data, Questions and Methods.- Health services research on access to care.- Waiting-time data used in this book.- Waits and outcomes: What should be reported?.- Waiting-time Studies.- Overview of waiting times and other variables.- Variation and access probabilities.- Factors influencing waiting times.- Surgery after target access time.- Adverse events while waiting.- Intermediate events.- Survival benefit of coronary artery bypass grafting.