Health and science notes from all over

[electricland]

Very excited about this pilot study on wait times for knee and hip replacements from Alberta.

The average wait for a first orthopedic consultation dropped to six weeks from 35 weeks, according to an interim report on the program released yesterday.

In the project, which sends patients through a central-intake system and has its own doctors and surgical space, the average wait for surgery after the first consultation has plummeted to 4.7 weeks from 47 weeks.

And the average hospital stay has shrunk to 4.3 days from 6.2 days.

Andre Picard's commentary is very good -- it will probably disappear behind a pay-for-me barrier tomorrow, so here it is:

For the estimated 20,000 Canadians currently on waiting lists for a new hip or knee (and the 50,000 others who will get a joint replacement this year after suffering too long in pain), there is finally some good news.

The Alberta Hip and Knee Replacement Project released some eye-popping numbers yesterday: The waiting time for an orthopedic consultation was reduced to six weeks from 35 weeks and the waiting time from the ortho consultation to surgery from 47 weeks to 4.7 weeks.

These numbers are even more impressive when they are put in context. Alberta already has some of the shortest waiting times -- in some provinces the wait for a new hip or knee still exceeds five years. Alberta also increased the volume of procedures by about 25 per cent, while it cut the wait.

So, how did they do it? With a bit of common sense.

Patients with an arthritic hip or knee want to be treated for the pain -- with drugs, surgery or whatever -- quickly and efficiently. They want to be back on their feet as soon as possible.

But in most of the country, a patient with hip or knee pain has to go through a series of interminable, seemingly unrelated procedures -- diagnosis by a GP, referral to a specialist, referral to diagnostic imaging, return to the specialist, referral to a surgeon, surgery, physiotherapy, occupational therapy, not to mention referrals to home care, pain clinics and emergency-room visits -- with each step punctuated by frustratingly long waits and crushing bureaucracy.

What the Alberta Bone and Joint Health Institute did was devilishly simple: They created a patient-friendly continuum of care.

In Edmonton, Calgary and Red Deer, everyone with serious hip or knee pain was referred to a central assessment clinic. No patient waited more than 17 days after a referral from a GP.

Patients who didn't need a hip or knee replacement were immediately triaged out. Those who did were assigned a care manager (a registered nurse) who guided them through the system, prepared them for surgery and ensured follow-up care such as physio.

The care manager connected the dots -- and eliminated virtually all the waits in the process.

There were also structural changes, namely dedicated orthopedic surgeons in clinics with operating rooms specifically designed for hip and knee replacements. In other words, specialization and the efficiency that entails.

All this was done within the medicare system -- though it should be noted some of the clinics doing the surgery were for-profit facilities and some were not-for-profits, but that is generally not something patients care about. What matters is that all the procedures were centrally administered and paid for from the public purse.

While some investment was required upfront, researchers figure the approach will be revenue neutral.

In other words, providing care quickly costs no more than providing it slowly -- except you eliminate the suffering.

Yes, this is only a pilot study. But the lessons learned to date are invaluable and timely as provinces and territories set out to achieve the benchmark waiting times that have been established by their political masters.

The Alberta study tells us that we have a health system that is fundamentally sound, but it needs to be funded adequately and managed effectively, and services need to be better integrated. It tells us that the solution to our waiting-list woes is threefold: Use an evidence-based approach, provide incentives for health-care providers to work collaboratively, and listen to patients.

Canada already has wonderful health professionals, great infrastructure and cost-efficient delivery of care.

What we need to work on is getting the right patients to the right place at the right time. When you do that, you provide superb care, and you don't have unduly long waits.

So what are we waiting for?

(The Alberta Hip and Knee Replacement Project's website has the full report [PDF].) Extremely promising -- and publicly funded too, whatever will they think of next? It sounds similar to Ontario's Cardiac Care Network, which is widely praised as an initiative that centralizes the bureaucracy, stays on top of patients' conditions and needs and moves them up and down the waiting list as necessary, streamlines the process of getting through the system, and generally Gets the Job Done. More, please. (Of course, I'm trying to figure out how to relate this to paediatrics for work, but I don't think the issues are really similar enough to do it -- so this is merely personal squee.)

And in cool science news from PNAS:

An Asian origin for a 10,000-year-old domesticated plant in the Americas

Grammatical Subjects in home sign: Abstract linguistic structure in adult primary gesture systems without linguistic input (language patterns developed by congenitally deaf people deprived of any speech or sign input)

Comments

[jenlev.livejournal.com]

thank you for the links and the article. and wow about the gourds. *hugs*

[life-on-queen.livejournal.com]

It's gonna be weird if Ralph Klein's "Why can't we have private healthcare if we want it" Alberta becomes a centre of patientcare innovation in the public system.