title: Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data.
abstract: BACKGROUND
  The Wait Time Alliance recently established wait time benchmarks for rheumatology consultations in Canada. Our aim was to quantify wait times to primary and rheumatology care for patients with rheumatic diseases.
  
  
  METHODS
  We identified patients from primary care practices in the Electronic Medical Record Administrative data Linked Database who had referrals to Ontario rheumatologists over the period 2000-2013. To assess the full care pathway, we identified dates of symptom onset, presentation in primary care and referral from electronic medical records. Dates of rheumatologist consultations were obtained by linking with physician service claims. We determined the duration of each phase of the care pathway (symptom onset to primary care encounter, primary care encounter to referral, and referral to rheumatologist consultation) and compared them with established benchmarks.
  
  
  RESULTS
  Among 2430 referrals from 168 family physicians, 2015 patients (82.9%) were seen by 146 rheumatologists within 1 year of referral. Of the 2430 referrals, 2417 (99.5%) occurred between 2005 and 2013. The main reasons for referral were osteoarthritis (32.4%) and systemic inflammatory rheumatic diseases (30.6%). Wait times varied by diagnosis and geographic region. Overall, the median wait time from referral to rheumatologist consultation was 74 (interquartile range 27-101) days; it was 66 (interquartile range 18-84) days for systemic inflammatory rheumatic diseases. Wait time benchmarks were not achieved, even for the most urgent types of referral. For systemic inflammatory rheumatic diseases, most of the delays occurred before referral.
  
  
  CONCLUSIONS
  Rheumatology wait times exceeded established benchmarks. Targeted efforts are needed to promote more timely access to both primary and rheumatology care. Routine linkage of electronic medical records with administrative data may help fill important gaps in knowledge about waits to primary and specialty care.
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: Jessica
authors.initials: J
authors.lastname: Widdifield
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: J Carter
authors.initials: JC
authors.lastname: Thorne
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: R Liisa
authors.initials: RL
authors.lastname: Jaakkimainen
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: Laura
authors.initials: L
authors.lastname: Wing
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: Noah
authors.initials: N
authors.lastname: Ivers
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: Debra
authors.initials: D
authors.lastname: Butt
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: Anne
authors.initials: A
authors.lastname: Lyddiatt
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hofstetter
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: Vandana
authors.initials: V
authors.lastname: Ahluwalia
authors.affiliation: Department of Clinical Epidemiology (Widdifield, Bernatsky), McGill University Health Centre, Montréal, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Widdifield, Bernatsky), McGill University, Montréal, Que.; Department of Rheumatology (Thorne), Southlake Regional Health Centre, Newmarket, Ont.; Departments of Family and Community Medicine (Jaakkimainen, Ivers, Butt, Tu) and Rheumatology (Bombardier), University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.; Department of Family Medicine (Butt), Scarborough Hospital, Toronto, Ont.; Patient representative (Lyddiatt), Ingersoll, Ont.; Patient representative (Hofstetter), Toronto, Ont.; Department of Rheumatology (Ahluwalia), William Osler Health Centre, Brampton, Ont.
authors.forename: Karen
authors.initials: K
authors.lastname: Tu