title: Prioritization of patients on waiting lists for hip and knee replacement: validation of a priority criteria tool.
abstract: OBJECTIVE
  This study tested the reliability and validity of the Western Canada Waiting List Project priority criteria score (PCS) for prioritizing patients waiting for hip and knee arthroplasty.
  
  
  METHODS
  Sixteen orthopedic surgeons assessed 233 consecutive patients at consultation for hip or knee arthroplasty. Measures included the PCS, a visual analogue scale of urgency (VAS urgency), and maximum acceptable waiting time (MAWT). Patients completed a VAS urgency, an MAWT, the Western Ontario McMaster Osteoarthritis Index (WOMAC), and the EQ-5D. Using correlational analysis, convergent and discriminant validity was assessed between similar constructs in the priority criteria and WOMAC. Median MAWTs were determined for five levels of urgency based on PCS percentiles. Internal consistency reliability was assessed with Cronbach's alpha.
  
  
  RESULTS
  The sample of 233 patients (62 percent female) ranged in age from 18 to 89 years (mean, 66.3 years). A total of 45 percent were booked for hip and 55 percent for knee arthroplasty. Correlations were strong between the PCS and surgeon VAS urgency (r = .79) and weaker between patient and surgeon measures of VAS urgency (r = .24) and MAWT (r = .44). Correlation coefficients between similar constructs in the priority criteria and WOMAC ranged from 0.24 to 0.32 and were higher than those measuring dissimilar constructs. For decreasing levels of urgency, the median MAWT ranged from 10 to 12 weeks for surgeons and 4 to 12 weeks for patients. Cronbach's alpha was 0.79.
  
  
  CONCLUSIONS
  Results support the validity of the PCS as a measure of surgeon-rated urgency. Patients might be ranked differently with different prioritization measures.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Western Canada Waiting List Project, Alberta, Canada. barbspady@shaw.ca
authors.forename: Barbara
authors.initials: B
authors.lastname: Conner-Spady
authors.forename: Angela
authors.initials: A
authors.lastname: Estey
authors.forename: Gordon
authors.initials: G
authors.lastname: Arnett
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ness
authors.forename: John
authors.initials: J
authors.lastname: McGurran
authors.forename: Robert
authors.initials: R
authors.lastname: Bear
authors.forename: Tom
authors.initials: T
authors.lastname: Noseworthy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000592:standards*; D019645:Arthroplasty, Replacement, Knee / Q000592:standards*; D002170:Canada; D005260:Female; D015276:Health Care Rationing; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015203:Reproducibility of Results; D014850:Waiting Lists