INNOVATIVE TECHNIQUES TO EVALUATE HEALTHCARE DELIVERY STRATEGIES TO REDUCE WAIT TIMES IN ORTHOPAEDIC FOOT CARE
Notice bibliographique
Résumé
Orthopaedic forefoot conditions such as bunion deformities, claw toes, and arthritis of the foot are often overlooked by our healthcare system. Access to care with orthopaedic foot and ankle (FA) specialists is concerningly difficult, leading to some of the highest wait times amongst all orthopaedic procedures. Unfortunately, the COVID-19 pandemic has further exacerbated an already troubling systemic issue in terms of adequate and efficient access to FA care. To help address the significant wait times and the backlog of cases, many hospitals have implemented different wait time reduction strategies (WTRS). Popular WTRS include expansion of virtual care, extended hours, and implementation of volume funding remuneration. The primary objective of this study is to determine which WTRS can most effectively address the wait times for FA surgery. The secondary objective will look at the cost-effectiveness of these WTRS. The workflow of an outpatient hospital in Canada was modeled retrospectively from 2016-2022 to assess the efficacy of the aforementioned WTRS. Data sources included hospital decision support, accounting, Ministry of Health wait times, and literature values. To accurately reconstruct the workflow, a discrete event simulation (DES) model was constructed. The DES structure was based on process mapping stemming from a combination of observing workflow, reviewing OR and clinic schedules, and expert opinion from clinicians and hospital management. The three WRTS models that were run included 1) virtual clinics, 2) extended surgical hours and 3) bundled payments model. The outcome metrics included: 1) throughput for clinic/ORs (number of patients seen/cases completed), 2) wait time reductions, and 3) financial impact. For the virtual clinic models, running a range of half to one day of additional virtual clinics reduced wait times by 40.2-58.9%. Ranging the proportion of clinics being virtually from 10% to 90% resulted in a decrease in wait times by 2.7%-25.9%. For extended surgical hours, running the model for a period of 200 OR days a year resulted in 719 cases completed (profit = $518,149.92). Adding one to three additional hours resulted in 816 to 1015 cases done, a 13.5 to 41.2% increase in throughput and $18,828.78 to $76,497.63 increase in profit. For the bundled payments model, the average profit per case without bundled payments was $660.78. Incorporating a bundled pay remuneration model of $1000-$8000 per case resulted in a profit of $-988.55 to $6011.45, with cases being profitable at remuneration of >$2000/case. This study demonstrates that wait time reduction strategies such as virtual clinics, extended surgical hours and bundled payment models have the potential to reduce wait times to clinics and ORs, increase surgical throughput and are financially more viable. Moreover, demonstrating this at an outpatient centre has broad implications in the Canadian healthcare context as it allows for an efficient and cost effective solution to the current surgical backlogs. Future work should aim to prospectively analyse how dedicated outpatient centres may improve patient care, decrease surgical wait times and reduce healthcare costs.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».