Wait Times in Canada: The Wait Time Alliance (WTA) Perspective

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Fay Tucker
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1 Wait Times in Canada: The Wait Time Alliance (WTA) Perspective Presentation to Taming of the Queue 2012 Dr. Chris Simpson, WTA Chair March 29, 2012

2 Tumor Doubling Time (weeks) Patients should not wait excessively for important medical care Tumour Doubling Time (weeks) by 300 Primary Cancer Site 128 studies of 8071 cases Prostate Breast Colorectal Gastric Lung Hepatic Pancreas Head/Neck

5 Current State (October 2007) - % of cases completed within target Cancer Surgery 100% 93% CT Expected Bypass Surgery 77% 100% 46% 0% 95% MRI Cataract Surgery 80% 85% Knee Replacement Hip Replacement Target Actual Note: Priority 4 targets used in absence of priority-level data. Angiography and Angioplasty Cardiac Data are currently unavailable. Source: Wait Times Information Office 5

6 Wait time guarantees 6 Provinces chose cancer (radiation therapy) as their target of choice and received share of $500m Province RT guarantee PEI NS NB Man Alta BC 8 weeks 8 weeks from referral 8 weeks 8 weeks 8 weeks 8 weeks * CIHI report: Wait Times Tables A Comparison by Province, 2007

7 Wait time guarantees Radiation therapy 6 Provinces chose cancer and received share of $500m Province RT guarantee Current wait time * PEI 8 weeks 2 wk NS 8 weeks < 4.1 wk from referral NB 8 weeks Man 8 weeks 1 wk Alta 8 weeks wk BC 8 weeks 0.9 wk * CIHI report: Wait Times Tables A Comparison by Province, 2007

8 Canadians want PM to place priority on health care Survey asked more than 1,200 Canadians to rate on a scale of 1 to 5 how highly they viewed nine possible priorities for this government. Here are the average scores each priority earned: Working with the provinces on health care Creating jobs through training Eliminating the deficit Cutting taxes Investing in research and development Getting tough on crime Focusing on new trade opportunities around the world Strengthening Canada's armed forces Reforming the Senate of Canada Source: Nanos Research, Institute of Research on Public Policy poll June 2, 2011

9 The Genesis of the WTA

of Emergency Physicians Canadian Association of

Canadian Association of Radiation Oncology Canadian

Society Canadian Ophthalmological Society Canadian

Canadian Society of Plastic Surgeons Society of

10 Who makes up the WTA? Canadian Anesthesiologists Society Canadian Association of Emergency Physicians Canadian Association of Gastroenterology Canadian Association of Nuclear Medicine Canadian Association of Radiation Oncology Canadian Association of Radiologists Canadian Cardiovascular Society Canadian Ophthalmological Society Canadian Orthopaedic Association Canadian Psychiatric Association Canadian Society of Plastic Surgeons Society of Obstetricians and Gynaecologists of Canada Canadian Association of Paediatric Surgeons Canadian Medical Association (secretariat)

11 WTA History Established following First Ministers 2004 Accord with commitment to reduce wait times Purpose: Ensure that physicians play leadership role in patient access (e.g., setting wait-time benchmarks) Hold governments accountable on their commitments to reduce wait times: Meaningful reductions in waits for priority areas (cancer, heart, DI, joint replacement, sight restoration)

12 Wait Times From the Patient s Perspective WTA wait time definition Testing Decision by patient to see family physician Family physician/gp consultation: Differential diagnosis & referral as needed Specialist consultation Decision to treat or refer back to family doctor Treatment received Rehabilitation (if necessary) and follow up with family physician and specialist Adapted from prototype shared by The College of Family Physicians of Canada and from ICES, Access to Health Services in Ontario, Fig. 1.1

13 WTA Mission The WTA is concerned over delayed access to care for Canadians. We work collaboratively with our stakeholders to inform, advocate, and provide solutions to achieve timely, appropriate and equitable access to high quality health care.

14 WTA Directions 1. Approach wait times from the patient s perspective 2. Add the Patient s Voice 3. Build Partnerships 4. Provide Solutions 5. Celebrate Success

15 WTA 2011 Report Card Time Out! WTA s 6 th annual report assigning grades Graded: 5 priority areas against government benchmarks Additional procedures/diagnoses graded against WTA benchmarks ALC Provincial wait time websites Links to WTA member leading practices

16 2011 WTA Report Card Provincial breakdowns for 5 priority areas

17 WTA s 5 Year Assessment National Grades Procedures Diagnostic Imaging Joint Replacement Radiation Cataract CT MRI Hip Knee Oncology Surgery CABG 4 weeks 4 weeks 26 weeks 26 weeks 4 weeks 16 weeks 26 weeks 2007 nb nb B B C B A 2008 nb nb B B B B A 2009 nb nb B C A A A 2010 nb nb B C A A A 2011 nb nb B C A B A 5 Year trend nb nb B C B B A 5 Year national grade: B

18 Table 3: Provincially Reported Wait Times Compared to Select WTA Benchmarks Treatment/service/procedure Anesthesiology (chronic pain) WTA Benchmark NL PE NS NB QC ON MB SK AB BC Acute neuropathic pain 30 days?????????? Cancer pain 2 weeks?????????? Cardiac Care (scheduled cases) $ $ $ $ $ $ $ Electrophysiology catheter ablation 90 days???? $????? Echocardiography 30 days?????????? Gastroenterology Cancer 2 weeks?????????? Inflammatory bowel disease (IBD) 2 weeks?????????? Emergency Department 4hrs/8hrs????? A/F?? A/D? Nuclear Medicine $ $ Bone scan -whole body 30 days?????????? FDG-PET 30 days?????????? Obstetrics and Gynaecology $ $ $ $ $ Abnormal premenopausal uterine bleeding 12 weeks?????????? Urinary incontinence 12 weeks??????? F?? Plastic Surgery $ $ Carpal tunnel release 2 months?? $ $??? F D? Skin cancer treatment 4 months??????? B? A Pediatric Surgery* $ Advanced Dental Caries: carious lesions/ pain 90 days????? $???? Cleft Lip/Palate 21 days????? $???? Psychiatry (scheduled) Early psychosis 2 weeks?????????? Postpartum severe mood disorders 4 weeks??????????

20 WTA assessment of wait-time commitments Slight improvement in reported wait times for 5 priority areas since 2007 Inconsistent reporting for other specialty areas; wait times frequently fall outside of acceptable wait-time benchmarks/targets Provincial reporting has improved but need more consistent and standardized reporting to properly assess progress Need to address regional variations

21 Next Steps: Improving wait time measures The WTA will continue to shed light on: (1) the wait that patients experience for a wider range of specialty care services (beyond the initial 5 identified by government); and (2) the total wait times that patients face in trying to access specialty care including access to primary care, chronic disease management and end of life care.

22 Canadian Health Care System

23 Toward a new professionalism Cost and Benefit together with Care and Trust Anchored in accountability Civic-oriented professionalism Seize the leadership of this issue A moral imperative A professional responsibility A professional social ideal

24 WTA website To access WTA reports, benchmarks, news releases etc

Thinkstockphotos.com. Canadians still waiting too long for health care. Report Card on Wait Times in Canada

Thinkstockphotos.com. Canadians still waiting too long for health care. Report Card on Wait Times in Canada TIME FOR TRANSFORMATION Thinkstockphotos.com Canadians still waiting too long for health care Report Card on Wait Times in Canada June 2013 Canadians still waiting too long for health care Overview Despite