Patient-Reported Outcomes and Waiting for Elective Surgery: Preliminary Findings
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Patient-Reported Outcomes and Waiting for Elective Surgery:
Preliminary FindingsJason M. Sutherland
Centre for Health Services and Policy ResearchUniversity of British Columbia
The Taming of the QueueAppropriateness and Accountability
April 4, 2014
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Disclosure
The research presented today is funded by:• Canadian Institute for Health Research (CIHR)• Vancouver Coastal Health Authority (in-kind)
Approved by:• University of British Columbia Behavioural
Research Ethics Board• Vancouver Coastal Health Authority Privacy Office
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Source: CIHI, CMS National Health Expenditure Historical Data
SpendingAnnual % change in total health and hospital spending, 1981-2012
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How are we doing?
Commonwealth Fund 2013
Germany
Switzerland
USA
Netherlands
New Zealand
France
UK
Australia
Sweden
Norway
Canada
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
waited 4 months or more for elective surgery waited 2 months or more for specialist apt
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What is missing?
Collect and measure patient-reported outcomes
• Completed by patients• Standardized, validated questionnaires• Measure self-perceived quality of life, functional
well-being and health status
• Generic or condition-specific
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Elective surgery– Measure patient’s reported outcomes prospectively– Evaluate changes in patients’ health over time
Self-reported health on the wait listMethods
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Where do we collect PROs?
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• 7 specialties; 6 hospitals in metro Vancouver region
Self-reported health on the wait listMethods
Gener
al Surg
ery
Plastic
s
Gynec
ology
Otolar
yngolo
gy
Urolog
y
Orthop
edics
Neuro
surg
ery
44%
16% 13% 12%7% 5% 2%
Response Rate:• Entering wait list: 45 %• Just before surgery: 68 %
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Self-reported health statusEQ-5D
Five domains:
1. Mobility2. Self-care3. Usual activities4. Pain / discomfort5. Anxiety / depression
AND A ranking of overall health status
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Self-reported health EQ-5D
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Self-reported pain
Three domains:
1. Intensity of pain2. Pain interference in
enjoyment of life3. Pain interference with
general activity
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Self-reported depression
Two domains: 1. Symptoms 2. Functional impairment
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Self-reported health
What does a patient’s self-reported health tell us at the start of their wait time?
1. Aspects of health are very good:• Usual activities• Function and Mobility
2. Largest potential for improving patient’s health:• Anxiety / Depression• Pain
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The wait and self-reported health
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What does patient’s change in self-reported health over the wait time tell us?
Self-reported health
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