Wait Times in Canada:The Wait Time Alliance (WTA) Perspective Presentation to Taming of the Queue 2012 Dr. Chris Simpson, WTA Chair March 29, 2012
Patients should not wait excessively for important medical care Tumour Doubling Time (weeks) by 520 300 Primary Cancer Site 260Tumor Doubling Time (weeks) 128 studies of 8071 cases 104 52 30 26 22 21 18 13 12 8 6 4 4 1 Prostate Breast Colorectal Gastric Lung Hepatic Pancreas Head/Neck
Current State (October 2007) - % of cases completed within target Cancer Surgery 100% 93% Expected CT Bypass Surgery 77% 100% 0% 46% 95% MRI Cataract Surgery 80% 85% Knee Replacement Hip Replacement Target ActualNote: Priority 4 targets used in absence of priority-level data. Angiography andAngioplasty Cardiac Data are currently unavailable. 5Source: Wait Times Information Office
Wait time guarantees 6 Provinces chose cancer (radiation therapy) as their target of choice and received share of $500m Province RT guarantee PEI 8 weeks NS 8 weeks from referral NB 8 weeks Man 8 weeks Alta 8 weeks BC 8 weeks* CIHI report: Wait Times Tables—A Comparison by Province, 2007
Wait time guarantees – Radiation therapy6 Provinces chose cancer and received share of $500m Province RT guarantee Current wait time * PEI 8 weeks 2 wk NS 8 weeks < 4.1 wk from referral NB 8 weeks Man 8 weeks 1 wk Alta 8 weeks 2-3.5 wk BC 8 weeks 0.9 wk* CIHI report: Wait Times Tables—A Comparison by Province, 2007
Canadians want PM to place priority on health care Survey asked more than 1,200 Canadians to rate on a scale of 1 to 5 how highly they viewed nine possible priorities for this government. Here are the average scores each priority earned:• Working with the provinces on health care - 4.32• Creating jobs through training - 4.01• Eliminating the deficit - 3.98• Cutting taxes - 3.69• Investing in research and development - 3.63• Getting tough on crime - 3.58• Focusing on new trade opportunities around the world - 3.48• Strengthening Canadas armed forces - 3.05• Reforming the Senate of Canada - 2.99Source: Nanos Research, Institute of Research onPublic Policy poll June 2, 2011
Who makes up the WTA? • Canadian Anesthesiologists’ Society • Canadian Association of Emergency Physicians • Canadian Association of Gastroenterology • Canadian Association of Nuclear Medicine • Canadian Association of Radiation Oncology • Canadian Association of Radiologists • Canadian Cardiovascular Society • Canadian Ophthalmological Society • Canadian Orthopaedic Association • Canadian Psychiatric Association • Canadian Society of Plastic Surgeons • Society of Obstetricians and Gynaecologists of Canada • Canadian Association of Paediatric Surgeons • Canadian Medical Association (secretariat)
WTA History– Established following First Ministers’ 2004 Accord with commitment to reduce wait times– Purpose: Ensure that physicians play leadership role in patient access (e.g., setting wait-time benchmarks)– Hold governments accountable on their commitments to reduce wait times: “Meaningful reductions” in waits for priority areas (cancer, heart, DI, joint replacement, sight restoration)
Wait Times From the Patient’s Perspective WTA wait time definition Testing Decision by Family Decision to treat or physician/GP Specialist Treatment patient to consultation refer back to family see family consultation: doctor received physician Differential diagnosis & referral as needed Rehabilitation (if necessary) and follow up with family physician and specialistAdapted from prototype shared by The College of Family Physicians ofCanada and from ICES, Access to Health Services in Ontario, Fig. 1.1
WTA Mission• The WTA is concerned over delayed access to care for Canadians. We work collaboratively with our stakeholders to inform, advocate, and provide solutions to achieve timely, appropriate and equitable access to high quality health care.
WTA Directions1. Approach wait times from the patient’s perspective2. Add the Patient’s Voice3. Build Partnerships4. Provide Solutions5. Celebrate Success
WTA 2011 Report Card• “Time Out!”• WTA’s 6th annual report assigning grades• Graded: – 5 priority areas against government benchmarks – Additional procedures/diagnoses graded against WTA benchmarks – ALC – Provincial wait time websites – Links to WTA member leading practices
2011 WTA Report CardProvincial breakdowns for 5 priority areas
WTA’s 5 Year Assessment 2007-2011National Grades Procedures Diagnostic Imaging Joint Replacement Radiation Cataract CT MRI Hip Knee Oncology Surgery CABG 4 4 weeks weeks 26 weeks 26 weeks 4 weeks 16 weeks 26 weeks2007 nb nb B B C B A2008 nb nb B B B B A2009 nb nb B C A A A2010 nb nb B C A A A2011 nb nb B C A B A5 Year trend nb nb B C B B A5 Year nationalgrade: B
Table 3: Provincially Reported Wait Times Compared to Select WTA Benchmarks WTATreatment/service/procedure Benchmark NL PE NS NB QC ON MB SK AB BCAnesthesiology (chronic pain) Acute neuropathic pain 30 days ? ? ? ? ? ? ? ? ? ? Cancer pain 2 weeks ? ? ? ? ? ? ? ? ? ?Cardiac Care (scheduled cases) $ $ $ $ $ $ $ Electrophysiology catheter ablation 90 days ? ? ? ? $ ? ? ? ? ? Echocardiography 30 days ? ? ? ? ? ? ? ? ? ?Gastroenterology Cancer 2 weeks ? ? ? ? ? ? ? ? ? ? Inflammatory bowel disease (IBD) 2 weeks ? ? ? ? ? ? ? ? ? ?Emergency Department 4hrs/8hrs ? ? ? ? ? A/F ? ? A/D ?Nuclear Medicine $ $Bone scan -whole body 30 days ? ? ? ? ? ? ? ? ? ?FDG-PET 30 days ? ? ? ? ? ? ? ? ? ?Obstetrics and Gynaecology $ $ $ $ $Abnormal premenopausal uterine bleeding 12 weeks ? ? ? ? ? ? ? ? ? ?Urinary incontinence 12 weeks ? ? ? ? ? ? ? F ? ?Plastic Surgery $ $ Carpal tunnel release 2 months ? ? $ $ ? ? ? F D ? Skin cancer treatment 4 months ? ? ? ? ? ? ? B ? APediatric Surgery* $ Advanced Dental Caries: carious lesions/pain 90 days ? ? ? ? ? $ ? ? ? ? Cleft Lip/Palate 21 days ? ? ? ? ? $ ? ? ? ?Psychiatry (scheduled) Early psychosis 2 weeks ? ? ? ? ? ? ? ? ? ? Postpartum severe mood disorders 4 weeks ? ? ? ? ? ? ? ? ? ?
WTA assessment of wait-time commitments• Slight improvement in reported wait times for 5 priority areas since 2007• Inconsistent reporting for other specialty areas; wait times frequently fall outside of acceptable wait-time benchmarks/targets• Provincial reporting has improved but need more consistent and standardized reporting to properly assess progress• Need to address regional variations
Next Steps: Improving wait timemeasuresThe WTA will continue to shed light on:(1) the wait that patients experience for a wider range of specialty care services (beyond the initial 5 identified by government); and(2) the total wait times that patients face in trying to access specialty care – including access to primary care, chronic disease management and end of life care.
Toward a new professionalism• Cost and Benefit together with Care and Trust – Anchored in accountability• Civic-oriented professionalism• Seize the leadership of this issue – A moral imperative – A professional responsibility – A “professional social ideal”
WTA websiteTo access WTA reports, benchmarks,news releases etc…http://www.waittimealliance.ca/