The Western Canada Waiting List Project: development of a priority referral score for hip and knee arthroplasty
Bibliographic record
Abstract
BACKGROUND: Recognizing the concerns about long waiting times to see some specialists in Canada, and the burden this places on both primary care and specialist clinicians, the Western Canada Waiting List (WCWL) undertook the Primary Care Project. The goal was to develop a valid, reliable, standardized prioritization tool for use by primary care providers in making referrals to specialists. WCWL is a 20-partner collaboration committed to addressing long waiting times to access scheduled health care services. METHODS: A previously developed prioritization tool for hip and knee replacement was adapted for use by family doctors, based on expert feedback from a clinical panel of primary care providers and from orthopaedic surgeons. Rater assessments of standardized paper cases were used to generate weights for criteria items in the Priority Referral Score (PRS). Intraclass correlations (ICCs) were calculated to assess reproducibility, and weights were estimated using a mixed-effects model. The weights and criteria items were modified following feedback of these results to the panel. The resulting PRS was reliability-tested with a different set of standardized case descriptions. RESULTS: One item was removed from the Hip and Knee Surgery tool and two items more pertinent to family medicine (mobility and medications) were added. The resulting eight-item PRS had a test-retest ICC of 0.84. The mean intrarater ICC was 0.79. CONCLUSIONS: An eight-item priority-setting tool has been developed to assist in queuing patients in order of urgency when they are referred to an orthopaedic surgeon for possible hip or knee arthroplasty. The tool had excellent inter- and intrarater reliability and was seen to have face validity by a panel of primary care providers who advised on the project.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.031 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".