Tracking Referral Wait Time from Primary to Specialty Care (AKA the Bane of Family Practice) About the Edmonton North PCN

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1 Tracking Referral Wait Time from Primary to Specialty Care (AKA the Bane of Family Practice) Margaret Wanke, MHSA Thanh Nguyen, MD, MPH, PhD Leanne McGeachy, MBA Kate Woodman, PhD Accelerating Primary Care Conference - October 4, 2011 About the Edmonton North PCN 126 family doctors working in 43 different clinics Our doctors provide care to 156,000 patients We have 85 staff and five priority initiatives, one of which is: Improving Links with Specialists Centralized referral program Customized database of specialists in the Edmonton Zone area Customized database that tracks all referrals made on behalf of our family doctors The majority of our doctors use the system, but the extent of use varies widely 7.5 FTE Referral Coordinators who process referrals (we do not process urgent referrals) 1

2 The referral process at the PCN Family Physician (FP) sees patient t (pt) & issues referral Referral request received by PCN PCN refers pt to specialist Appt. is booked Appt. date giventopt and FP Date of first appoint. PCN/FP receives consult; file is closed Value the PCN adds to the process Database of specialist information is current System tracks wait times for each specialist so can refer to the one with the shortest wait Staff do relevant investigations to improve the quality and appropriateness of a referral We have put other programs in place to support the process, such as our ortho triage pilot program Methods Trend analysis: Jan 1, 2009 Aug 31, 2011 Outcomes variable: Wait time to appointment Independent variables: Patient characteristics: age, sex, and address Referral characteristics: years, seasons, referral mode, urgency, re referral, follow up, specialties Statistical methods: Descriptive statistics Regression analyses 2

3 Timeframe used in this presentation Family Physician (FP) sees patient (pt) & issues referral Referral request received by PCN PCN refers pt to specialist Appt. is booked Appt. date given to pt and FP Date of first appoint. PCN/FP receives consult; file is closed Wait time to date of appointment Number of referrals by year by acceptance & re-referral upon referral decline (Jan Aug) Total Total 14,157 16,984 10,422 41,563 Of the total: Referrals 85% 86% 90% 87% accepted Re referrals upon referral decline 15% 14% 10% 13% Wait-time to appointment date by referrals and re-referrals all specialties, all years Mean days Median days p90% Referrals Re referrals

4 Wait time to appointment date: Referrals only % of Referrals Jan Aug Wait time time <3 months * >3 months * * represents statistically significant difference from 2009 Wait time to appointment date: Re-referrals only % of Re referrals Jan Aug 2011 Wait timetime <3 months 32 40* 56* >3 months 68 60* 44* * Represents statistically significant difference from 2009 LESSON #1 Reducing the number of re referrals is a significant opportunity for improvement (and one that the PCN appears to be making) 4

5 Difference in wait-time between modes of referral - all specialties & yrs Mode Wait time mean Wait time median Wait time p90% Phone first 63 days 45 days 128 days Difference from phone first: Letter only +23 days* +16 days* +31 days* * All differences are statistically significant Number of referrals by year by referral mode (Jan Aug) Total Total referrals 14,157 16,984 10,422 41,563 Of the total Phone first 29% 24% 25% 26% Letter only 69% 73% 74% 72% Sum may not equal to 100% due to unknown mode LESSON #2 The wait time for a specialist appointment could be notably decreased dif specialists booked using phone first 5

6 Highlights from two specialties: Orthopedics Gastroenterology Number of patients with re-referrals by year: Orthopedics No. of Re No. of Patients by Year Referrals Jan Aug Total Total Differences in wait-time (days) by year by referrals and re-referrals: Orthopedics Year Referrals Re referrals Mean Median p90% mean median p90% 2009 (Reference) * * 3 120* 2011 (Jan. Aug.) * 127* 95* 242* * represents statistical significance 6

7 Number of patients with re-referrals by year: Gastroenterology No. of Patients by Year No. of Re Total Referrals Jan Aug Total Differences in wait-time (days) by years by referrals and re-referrals: Gastroenterology Referrals Re referrals Year Mean Median p90% Mean Median p90% 2009 (Reference) * 18* 56* 123* 89* 208* 2011 (Jan. Aug.) 63* 48* 137* 204* 145* 373* All differences are statistically significant LESSON #3 We believe this is the most comprehensive, detailed and accurate data from a primary care perspective that demonstrates the difficulty of referring a patient from primary to specialty care.... 7

8 However, Our analysis is limited by the absence of control data needed to attribute observed changes solely to the PCN program Our next steps Work to further improve PCN processes and seek specialties to work collaboratively for benefit of both primary & specialist care, including better understanding of the data With full data for 2011, will seek to publish these results LESSON #4 Positive, proactive improvements are possible (and measurable) to this complex and difficult issue 8

9 Contact information for questions, additional data or to view our database Edmonton North PCN Leanne McGeachy, General Manager 1038, th Avenue, Edmonton, AB, T5E 5R8 P: (780) (direct) E: Charis Management Consulting Margaret Wanke, Principal St NW, Edmonton, AB T5J 3H1 P: (780) E: 9