Patient-reported outcomes and surgical triage: A gap in patient-centered care?
To help address wait times for elective surgery, British Columbia has implemented a triaging system that assigns priority levels to patients based on their diagnoses. The extent to which these priority levels concords with patients' assessment of their health status is not known. The purpose of this study was to measure the association between the priority levels assigned to patients and their patient-reported outcomes data collected at the time of being enrolled on the surgical wait list.



Patients waiting for elective surgery in the Vancouver Coastal Health Authority were sampled. Participants completed a set of generic and condition-specific patient-reported outcome instruments, including: the EQ-5D(3L) (general health), PEG (pain), and the PHQ-9 (depression). A multivariate ordered logistic model was used to regress patient-reported outcome values on the priority level assigned at the time of wait list registration.



A total of 2725 participants completed the survey package (response rate 49 %). Using the EQ-5D(3L), 63 % reported having problems with pain or discomfort, 41 % problems performing usual activities, 36 % problems with depression or anxiety, 28 % problems with mobility, and 8 % a problem with self-care. The results from the ordered logistic model indicated very little association between the patient-reported outcomes and wait list priority levels, when adjusted for patient factors.



This study observed no relationship between patients' self-reported health status and their assigned priority level for elective surgery. A more patient-centered approach to triaging patients for surgical treatment would incorporate patients' perspective in surgical wait list prioritization systems.
The Children's Research Institute of the Children's Hospital of Wisconsin, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA. tcrump@ucalgary.ca.
R Trafford
RT
Crump
Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201 - 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
Guiping
G
Liu
Vancouver Coastal Health, Vancouver, BC, V5Z 4H5, Canada.
Mark
M
Chase
Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201 - 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
Jason M
JM
Sutherland
D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D018802:Patient-Centered Care / Q000379:methods*; D012648:Self Care; D014218:Triage; D014850:Waiting Lists
Canada; Elective surgical procedures; Health status; Self-report; Survey; Waiting lists