Seasonality of service provision in hip and knee surgery: A possible contributor to waiting times? A time series analysis

University of Toronto, Toronto, Ontario, Canada
BMC Health Services Research (Impact Factor: 1.71). 02/2006; 6(1):22. DOI: 10.1186/1472-6963-6-22
Source: PubMed


The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario.
We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100,000 population for all hip and knee replacements.
There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p < 0.01; Bartlett-Kolmogorov-Smirnov Test = 0.31, p < 0.01) and strong (R2Autoreg = 0.85) seasonality was identified in the data.
Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.

Download full-text


Available from: Eric Crighton, Aug 19, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Orthopedics has its own specificities in terms of costs, primarily related to the purchase of orthopedic devices and usage of operating rooms, as well as in terms of management issues connected with the organization of medical staff, nursing care, and ancillary support. This paper analyzes the application of benchmarking techniques in the health care sector. It discusses opportunities and limits of benchmarking in the public service sector, focusing on orthopedics; a sector characterized by its own specificities in terms of costs, organization, and management. Methods This paper takes into consideration the first Italian benchmarking project realized in orthopedics that involved three Italian centers of excellence: IRCCS Istituto Ortopedico Galeazzi (Milan), Azienda Ospedaliera CTO—Maria Adelaide (Turin), and IRCCS Istituto Ortopedico Rizzoli (Bologna). It aimed to carry out a comparative analysis in order to identify the best performance and to improve the service and the organizational effectiveness. Results Relevant differences were assessed between the three hospitals involved and possible areas of innovation were detected. Discussion The results of the study highlight the significant reproducibility of benchmarking techniques due to the opportunity of standardizing procedures. Moreover, the differences concerning location, ownership, supply, purchasing, and accreditation processes, each one a potential limitation, provide information that is helpful in identifying relative gaps and that suggest paths leading to improvement.
    Full-text · Article · Sep 2012
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper assesses variations in the cost of primary hip replacement between and within nine member states of the European Union (EU). It also compares the cost of service with public-payer reimbursements. To do so, data on cost and reimbursement were surveyed at the micro-level in 42 hospitals in Denmark, England, France, Germany, Hungary, Italy, The Netherlands, Poland, and Spain. The total cost of treatment ranged from 1290 euros (Hungary) to 8739 euros (The Netherlands), with a mean cost of 5043 euros (STD +/- 2071 euros). The main cost drivers were found to be implants (34% of total cost on average) and ward costs (20.9% of total cost on average). A one-way random effects analysis of variance model indicated that 74.0% of variation was between and only 26% of variation was within countries. In a two-level random-intercept regression model, purchasing-power parities explained 79.4% of the explainable between-country variation, while the percentage of uncemented implants used and the number of beds explained 12.1 and 1.6% of explainable within-country variation, respectively. The large differences in cost and reimbursement between Poland, Hungary, and the other EU member states shows that primary total hip replacement is a highly relevant case for cross-border care.
    Full-text · Article · Jan 2008 · Health Economics
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Governments in Canada have committed $5.5 billion to shorten waiting lists. There is little information about changes in waiting lists over time except the perception that they are getting longer. Monthly data from the Misericordia Cataract Waiting List Program from 2000 to 2006 were used to examine changes in the length of the waiting list per surgeon over time. The data were analyzed to see whether changes in the length of a surgeon's list from month to month appeared to influence his or her threshold for booking surgery. The overall length of the waiting lists decreased during the study period. Individual surgeons' lists fluctuated markedly. Surgeons were not found to adjust their threshold for booking surgery to maintain the length of their lists. Committing extra resources to shorten waiting lists is successful. Surgeons do not appear to be manipulating their threshold for booking surgery to maintain the length of their waiting list. Individual surgeons' waiting list lengths are surprisingly dynamic. More study is needed on the variation in length of waiting lists and the longitudinal change over time if all patients are to receive their surgery within recommended benchmark wait times.
    Preview · Article · Nov 2008 · Canadian Journal of Ophthalmology
Show more