Indicator Definition - Wait Time for Hip Replacement Surgery

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                                                 Wait Time for Hip Replacement Surgery

            Name of Measure               Wait Time for Elective Hip Replacement Surgery: 90th percentile wait time (in weeks) from
                                          date of decision to treat, to date of treatment.
            Name of Measure (short)       Hip Replacement Surgery 90th Percentile Wait Time
            Definition                    The wait time for hip replacement surgery is the 90th percentile wait time (in weeks) from
                                          the decision to treat date to the treatment date.
            Domain                        Quality of Health Services. Dimension of Quality: Accessibility.
            Type of Measure               Process Measure
            Business Context              This performance measure supports AHS and government accountability and reporting
                                          processes related to health system performance. For example:

                                           • Health and Wellness Ministry 2010-2013 Business Plan:
                                              Performance measure 5.d.: Wait time for hip replacement surgery: 90th percentile wait
                                              time in weeks, as listed under Goal 5, Appropriate access to services across the
                                              continuum of care .
                                           • Alberta Health Services 2010 – 2015 Health Plan.
                                           • AHS Senior Leadership Performance Targets.
                                           • For annual reporting, the calculation uses data from patients served in the fiscal period
                                           April 1 to March 31.
                                           • For AWR monthly reporting: Waitlisted cases completed between rolling 3 month period
                                           prior to current reporting month end.
                                           • For quarterly reporting: Waitlisted cases completed during the reporting quarter: June 30,
                                           September 30, December 31, and March 31.
            Rationale                     Providing reasonable access to health service is a major objective and a defining attribute of
                                          the publicly funded health system. Longer waits affect health status and quality of life and
                                          result in more costly health services.
            Notes for Interpretation      Patient related delays (surgeon preference, available times, or medical reasons) are
                                          included in wait time calculations.
            Organizational Strategy       This measure supports the strategy to reduce the wait time for surgical procedures.
            Benchmark Comparisons         The Provincial/Territorial Benchmark for hip replacement surgery is completion of hip
                                          replacement surgery within 26 weeks.
            Cited                           Draft Tier 1 Performance Measures for Alberta Health Services linked to 5-Year Funding
            References:                   2010-2015, Alberta Health and Wellness (2010).
                                            Health and Wellness 2010 to 2013 Ministry Business Plan, Alberta Health and Wellness
                                          (2010), page 8.
                                            Final Report of the Federal Advisor on Wait Times. Cat.:H21-272/2006E-PDF. ISBN: 0-
                                          662-43474-9. Health Canada (June 2006), page 21.

AHS Performance Report – September 2010                                                                                Page 1 of 5

                                               Wait Time for Hip Replacement Surgery (continued)

            Technical Specifications
            Metric                             90 Percentile in Weeks
            Preferred Display Format           9.9
            Numerator                          Number of days that patients with an elective hip replacement surgery performed had
                                               waited, converted to weeks.
                      Inclusion Criteria for   • All elective hip replacement surgeries
                      Numerator                  (based on OR procedure catalogue descriptions)
                                               • All urgency levels
                      Exclusion Criteria for   • Emergency cases
                      Data Source(s) for       Data extracts from hospital Operating Room (OR) Information Systems
                      Numerator                Calgary – PICIS
                                               Edmonton – VAX and PICIS.
                                               Red Deer, Lethbridge Medicine Hat and Grande Prairie – MediTech Operating Room
                                               Module (ORM)
                                               Westlock, Bonnyville, and Camrose – data source to be determined
                      Refresh Rate of          Monthly
            Denominator                        Not applicable
                      Inclusion Criteria for   Not applicable
                      Exclusion Criteria for   Not applicable
                      Data Source(s)           Not applicable
                      for Denominator
                      Refresh Rate of          Not applicable

AHS Performance Report – September 2010                                                                                 Page 2 of 5

                                          Wait Time for Hip Replacement Surgery (continued)
            Technical Notes               A percentile is defined as a point on a rank-ordered scale, found by sorting a group of
                                          observations in order of magnitude from lowest to highest. The first percentile approximates
                                          the very lowest/bottom number found, while the 100th percentile is the very highest
                                          reported. The nth percentile is the point exceeding n percent of the observations. As follows,
                                          the 90th percentile wait time is the observed wait time that is equal to or greater than 90
                                          percent of other observations.

                                          Decision date is the date the patient and surgeon decide upon a surgical intervention. If not
                                          available, then the date the facility received the service request (booking date) is used.

                                          Treatment date is the date the surgical intervention took place.
            Calculation                   For a set of measurements arranged in order of magnitude, the pth, in this case, 90th
                                          percentile is the value that has p, or 90 percent of the measurements below it and (100-p),
                                          or 10 percent above it.

                                          The 90 percentile is calculated using the percentile function in Microsoft Excel.

                                          AHW SAS Code Used for BIE Analytics:
                                          The 90 percentile statistic is obtained by use of a SAS module PROC MEANS, to produce
                                          simple univariate descriptive statistics for numerical variables. The BY variable in this case
                                          is WAITLIST_INTERVENTION_RCAT_ID=10, and the numerical variable is weeks_wait,
                                          which is the calculated wait time for each observation. The selected SAS output statistic for
                                          90 percentile is P90.
                                          SAS code for calculation of percentile is as follows:

                                          data AWRBIE_SELECT_INTV_FY; set ods_prod.Detailed_waitlist_event_awr_v_i2;
                                          start_date = '01Apr2009:0:0:0'dt;
                                          end_date = '31Mar2010:0:0:0'dt;

                                          data AWRBIE_SELECT_INTV; set AWRBIE_SELECT_INTV_FY;
                                          if date_off ge start_date and date_off le end_date
                                             INCLUDE_IN_MWT_IND EQ 'Y'
                                             SCHEDULED_FOLLOWUP_IND ne 'Y'
                                             INTERVENTION_POSTPONED_IND NE 'Y'
                                              ( MISSING(DECEASED_DT)
                                                OR DECEASED_DT gt end_date )
                                             (WAITLIST_INTERVENTION_RCAT_ID eq 10)

                                          data AWRBIE_SELECT_INTV_FY;
                                          set AWRBIE_SELECT_INTV AWRBIE_SELECT_INTV;
                                          proc sort data=AWRBIE_SELECT_INTV_FY;
                                          by REPORT_CATEGORY_ID weeks_wait;

                                          PROC MEANS DATA=AWRBIE_SELECT_INTV_FY;

AHS Performance Report – September 2010                                                                                Page 3 of 5

                                          Wait Time for Hip Replacement Surgery (continued)
            Calculation (continuted)
                                          BY REPORT_CATEGORY_ID;
                                          VAR weeks_wait;
                                          ID REPORT_CATEGORY_ID;
                                          OUTPUT OUT=AR_FY_WT_STATS p90=WT90th;
                                          title 'AWR 90th Percentile Wait Times for Hip Replacement Surgery';
                                          proc print;
                                             run; endrsubmit;
            Relationship to               Wait Time for Knee Replacement Surgery: 90 Percentile
            Other Indicators
            Level of Reporting            • Provincial
                                          • Zone
                                          • Facility
            Frequency of Reporting        Annually, Quarterly, Monthly

            Limitations                   • The quality of data available may limit reporting on this measure.
                                          • The calculation for wait times is from Decision Date to the date surgery was completed.
                                          This indicator does not measure the entire wait time from a patient perspective. The wait
                                          time between referral from a family practitioner to the time seen by a specialist is not
                                          • For some facilities the data source for this indicator are Operating Room Information
                                          Systems (ORIS). Entry of correct decision dates in the ORIS is required for accurate
                                          calculation of wait times. OR booking information is not entered in real time so if the
                                          decision date is not backdated the start date of the wait time will be wrong. In some cases
                                          the decision date is not recorded. Terminology and abbreviations used to identify
                                          procedures used in the ORIS Catalogues is not standardized or even similar. This can result
                                          in questionable comparability.
                                          • Monthly data is available within 21 days of month end.

                     Approved on September 14, 2010 by the PMISC steering committee.

AHS Performance Report – September 2010                                                                             Page 4 of 5

                                                 Wait Time for Hip Replacement Surgery (continued)

          Document Version History

                                                   Version                              Summary of
                                                    Date                                 Changes

                      1.0                 May 18, 2010             Final version for initial use.
                                          May 18, 2010             Initial development, transfer to final template
                      1.1                 May 27, 2010             Review and completion of final template.
                                          June 2, 2010             Modify formatting.
                                          June 30, 2010            Add approval statement.
                                          July 21, 2010            Review, modify content.
                                          July 28,2 010            Review, modify content.
                                          August 12, 2010          Review, adjust formatting.
                      2.0                 September 14, 2010       Formal signoff received.
                                          October 13, 2010         Add new signoff page.
                                          October 25, 2010         Transfer to web version.

                      2.1                 November 8, 2010         Corrected hospital location from Peace River to
                                                                   Grande Prairie in Data Source for Numerator.

AHS Performance Report – September 2010                                                                              Page 5 of 5

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