title: Determinants of patient and surgeon perspectives on maximum acceptable waiting times for hip and knee arthroplasty.
abstract: OBJECTIVE
  Lengthy waiting times for hip and knee arthroplasty have raised concerns about equitable and timely access to care. The Western Canada Waiting List project has developed priority criteria scores linked to maximum acceptable waiting times (MAWT) for different levels of priority. Our study purpose was to assess the determinants of patient- and surgeon-rated MAWT, and to test whether the anticipated waiting time has an independent influence after adjusting for age, sex and patient urgency. A second aim was to compare MAWT, waiting time and anticipated waiting time for different levels of urgency assessed using the priority criteria score.
  
  
  METHODS
  Orthopaedic surgeons assessed 233 consecutive patients waiting for arthroplasty in terms of their urgency (assessed using the priority criteria score and a visual analogue scale), MAWT and anticipated waiting time. Patient data included urgency (assessed by a visual analogue scale), MAWT and the Western Ontario McMaster Osteoarthritis index. We used hierarchical linear regression to test the models.
  
  
  RESULTS
  After adjusting for age and sex, urgency (assessed by priority criteria score and visual analogue scale) and anticipated waiting time accounted for 40% of the variance in surgeon MAWT. The patient model accounted for 30% of the variance in patient MAWT. Older patients preferred signficantly shorter MAWTs (P <0.05). Anticipated waiting time added significantly to both the surgeon and patient MAWT models (R(2) change 0.11 and 0.07, respectively). Actual waiting time was weakly correlated with urgency assessed using the priority criteria score (r = -0.25, P <0.0001).
  
  
  CONCLUSIONS
  Patients' and surgeons' views are critical to a fair process of establishing MAWT for elective procedures. Anticipated waiting time may influence the perspectives on MAWT and must be considered in their interpretation.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Canada.
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: D000368:Aged; D000416:Alberta; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D013502:General Surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010820:Physicians / Q000523:psychology*; D014850:Waiting Lists; D000078329:Workforce