Perceptions of Ontario health system leaders on single-entry models for managing the COVID-19 elective surgery backlog: an interpretive descriptive study

Shapiro, Jonathan S.; Axelrod, Charlotte; Levy, Ben; Sriharan, Abi; Bhattacharyya, Onil; Urbach, David R.

doi:10.9778/cmajo.20210234

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…Centralized referral systems designed to improve timely access to procedures have only recently been implemented in Ontario for hip and knee replacement and anorectal surgeries, and there is still a dearth of evidence as to whether these systems reduce gender-based biases in referrals. However, a recent qualitative study suggested such systems may be gaining acceptability in the current environment, as solutions are needed to address the surgical backlogs precipitated by SARS-CoV-2 infection …”

Section: Discussionmentioning

confidence: 99%

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Referring and Specialist Physician Gender and Specialist Billing

Chami,

Weir,

Shaikh

et al. 2023

JAMA Netw Open

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ImportanceWhile a gender pay gap in medicine has been well documented, relatively little research has addressed mechanisms that mediate gender differences in referral income for specialists.ObjectiveTo examine gender-based disparities in medical and surgical specialist referrals in Ontario, Canada.Design, Setting, and ParticipantsThis cross-sectional study included referrals for specialist care ascertained from Ontario Health Insurance Plan physician billings for fiscal year 2018 to 2019. Participants were specialist physicians who received new patient consultations from April 1, 2018, to March 31, 2019, and the associated referring physicians. Data were analyzed from April 2018 to March 2020, including a 12-month follow-up period.ExposuresSpecialist and referring physician gender (female or male).Main Outcomes and MeasuresRevenue per referral was defined based on an episode-of-care approach as total billings for a 12-month period from the initial consultation. Mean total billings for female and male specialists were compared and the differential divided into the portion owing to referral volume vs referral revenue. Difference-in-differences multivariable regression analysis was used to estimate gender-based differences in revenue per referral. For each referring physician, gender-based differences in referral patterns were examined using case-control analysis, in which specialists who received a referral were compared with matched control specialists who did not receive a referral. This analysis considered the gender of the specialist and concordance between the gender of the referring physician and specialist, among other characteristics.ResultsOf 7 621 365 new referrals, 32 824 referring physicians, of whom 13 512 (41.2%) were female (mean [SD] age, 46.3 [11.6] years) and 19 312 (58.8%) were male (mean [SD] age, 52.9 [13.5] years), made referrals to 13 582 specialists, of whom 4890 (36.0%) were female (mean [SD] age, 45.6 [11.0] years) and 8692 (64.0%) were male (mean [SD] age, 51.8 [13.0] years). Male specialists received more mean (SD) referrals than did female specialists (633 [666] vs 433 [515]), and the mean (SD) revenue per referral was higher for males ($350 [$474]) compared with females ($316 [$393]). Adjusted analysis demonstrated a −4.7% (95% CI, −4.9% to −4.5%) difference in the revenue per referral between male and female specialists. Multivariable regression analysis found that physicians referred more often to specialists of the same gender (odds ratio, 1.04; 95% CI, 1.03-1.04) but had higher odds of referring to male specialists (odds ratio, 1.10; 95% CI, 1.09-1.11).Conclusions and RelevanceIn this cross-sectional study of the gender pay gap in specialist referral income, the number and revenue from referrals received differed by gender, as did the odds of receiving a referral from a physician of the same gender. Future research should examine the effectiveness of different policies to address this gap, such as a centralized, gender-blinded referral system.

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Section: Discussionmentioning

confidence: 99%

“…However, a recent qualitative study suggested such systems may be gaining acceptability in the current environment, as solutions are needed to address the surgical backlogs precipitated by SARS-CoV-2 infection. 32 …”

Section: Discussionmentioning

confidence: 99%

Referring and Specialist Physician Gender and Specialist Billing

Chami,

Weir,

Shaikh

et al. 2023

JAMA Netw Open

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“…SEMs require an iterative process of quality improvement where feedback is provided by patients, referring health care providers, and those who treat these patients, and the centralized collection of patient and provider data helps to identify gaps in care. 10 The quasi-objective criteria of urgency and necessity in triaging patients within SEMs helps improve equity and access to treatment. 10 Previous research has highlighted patient and provider satisfaction after SEMs were implemented.…”

Section: Introductionmentioning

confidence: 99%

“… 10 The quasi-objective criteria of urgency and necessity in triaging patients within SEMs helps improve equity and access to treatment. 10 Previous research has highlighted patient and provider satisfaction after SEMs were implemented. 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

Improving access to chronic pain care with central referral and triage: The 6-year findings from a single-entry model

Di Renna,

Burke,

Bhatia

et al. 2024

Canadian Journal of Pain

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Background Despite the established efficacy of multidisciplinary chronic pain care, barriers such as inflated referral wait times and uncoordinated care further hinder patient health care access. Aims Here we describe the evolution of a single-entry model (SEM) for coordinating access to chronic pain care across seven hospitals in Toronto and explore the impact on patient care 6 years after implementation. Methods In 2017, an innovative SEM was implemented for chronic pain referrals in Toronto and surrounding areas. Referrals are received centrally, triaged by a clinical team, and assigned an appointment according to the level of urgency and the most appropriate care setting/provider. To evaluate the impact of the SEM, a retrospective analysis was undertaken to determine referral patterns, patient characteristics, and referral wait times over the past 6 years. Results Implementation of an SEM streamlined the number of steps in the referral process and led to a standardized referral form with common inclusion and exclusion criteria across sites. Over the 6-year period, referrals increased by 93% and the number of unique providers increased by 91%. Chronic pain service wait times were reduced from 299 (±158) days to 176 (±103) days. However, certain pain diagnoses such as chronic pelvic pain and fibromyalgia far exceed the average. Conclusions The results indicate that the SEM helped reduce wait times for pain conditions and standardized the referral pathway. Continued data capture efforts can help identify gaps in care to enable further health care refinement and improvement.

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“… 15 , 17 , 19 As the pandemic evolved, research and recommendations focused more on guiding surgical recovery efforts. 5 , 21 - 23 However, anecdotal evidence suggests that there was no consensus or universally adopted approach for managing surgical care across Canada, and there has been little cross-jurisdictional interaction towards planning the way forward for surgical care in Canada. This may be a missed opportunity to learn from successes and challenges during the COVID-19 pandemic and in other times of constrained healthcare resources.…”

Section: Introductionmentioning

confidence: 99%

Delivery and Prioritization of Surgical Care in Canada During COVID-19: An Environmental Scan

Ibadin,

Brindle,

Wasylak

et al. 2023

Int J Health Policy Manag

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Background: During COVID-19 healthcare systems had to make concessions to make room for the surge of COVID-19 patients requiring hospital and intensive care. Postponing surgeries was a common strategy; however, it is unclear how surgical care was delivered during this time of constraint. The objective of this study was to understand how surgical care was delivered and prioritized during the COVID-19 pandemic response. Methods: This was an environmental scan following the Canadian Agency for Drugs and Technologies in Health methodology. This study was conducted in Canada; a universal, publicly funded healthcare system. Evidence sources on policies pertaining to the provision of surgical care between January 2020 and October 2022 were obtained from ministries of health, health services agencies and publicly funded hospitals across all 10 provinces and three territories. We synthesized the evidence sources using framework analysis. Results: We identified 205 evidence sources that described six themes about the provision of surgical care during the COVID-19 pandemic: the cycle of postponement and resumption; guidelines for triaging and prioritizing surgical cases; Infection Prevention and Control (IPAC), and safety measures for surgical care during COVID-19, patient-centred care, and looking forward (recovery planning, leadership, and decision-making). Conclusion: This study provides a comprehensive understanding of how surgical care was disrupted and innovated during COVID-19 which can inform future strategies for providing effective and efficient surgical care during times of healthcare constraint.

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Perceptions of Ontario health system leaders on single-entry models for managing the COVID-19 elective surgery backlog: an interpretive descriptive study

Cited by 5 publications

References 23 publications

Referring and Specialist Physician Gender and Specialist Billing

Referring and Specialist Physician Gender and Specialist Billing

Improving access to chronic pain care with central referral and triage: The 6-year findings from a single-entry model

Delivery and Prioritization of Surgical Care in Canada During COVID-19: An Environmental Scan

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