Chester Gillan, Minister of Health, today announced that the PEI Government is committed to improving access to services in the five national priority areas for wait times. These areas include cancer, heart, diagnostic imaging, sight restoration and joint replacement. PEI will also strive to meet other priorities that are important to providing quality care to Islanders.
The Department of Health has agreed to adopt the national indicators and benchmarks established by the Provinces and Territories as announced last week in Toronto.
Minister Gillan noted, “A benchmark is the amount of time that scientific evidence determines is an appropriate time to wait for a particular procedure. When sufficient scientific evidence is not available, Access Targets are utilized and based on the expert clinical opinion of physicians, surgeons and other health care providers.”
PEI, along with other Provinces and Territories, will work with the Canadian Institute for Health Information (CIHI) to determine a consistent approach to measure and report the indicators associated with the priority wait time areas.
Following consultation with PEI physicians who work in the benchmark areas, the Department of Health released the latest PEI wait time data for the priority indicators.
“Jurisdictions collect information in a variety of ways and we need to make changes in how we collect our information to be consistent with other provinces and territories,” added Minister Gillan. “With challenges in technology and available resources, there are limits on what data we can communicate at this point of time.”
PEI will set multi-year targets to achieve benchmarks. Work will begin immediately to develop a comprehensive strategy and action plan. Physicians, surgeons, other health care providers and health system staff will work collaboratively to develop the strategy. The strategy will utilize federal wait times funding and consider improvements in technology, wait list management and process changes necessary to improve access.
Minister Gillan said, “It is important to note that people needing immediate care are not placed on a wait list. Emergency cases are dealt with on a priority basis.”
Funds have been used for various improvements to the Queen Elizabeth Hospital, including the Emergency Department, Surgical Areas, Ambulatory Care and Diagnostic Imaging Department. Investments include the addition of new staff, including nurses in various clinical areas.
Investments have also been made with the opening of the new Cancer Treatment Center and the new Prince County Hospital. At the Prince County Hospital, funds to help improve wait times have been used in the Surgical Area and Ambulatory Care Department.
“This additional infrastructure will help provide a foundation to allow PEI to move forward in reducing wait times. We will continue to work on improvements to information technology and resources needed to improve the collection of data and monitoring of wait times,” said Minister Gillan.
BACKGROUNDER I
PEI Wait Time Information - Health Services
January 2005 – June 2005
The following information reflects Prince Edward Island wait times for national priority services, identified as part of the First Ministers’ 10-Year Plan to Strengthen Health Care.
The current data systems on PEI do not allow the Department of Health to report information as described in the benchmarks. PEI, along with the other provinces and territories, will be working with the Canadian Institute for Health Information (CIHI) to determine how to consistently measure wait time for purposes of comparability.
Data cannot be reported in direct comparison to the national benchmarks. Currently PEI is reporting median wait times, which means 50 percent of the patients on a wait list receive services less than the reported wait time while the rest of the patients on the wait list are waiting longer than the provincially reported wait time.
Once the data requirements are determined, the Department of Health will be developing information systems to collect that information. Table 1 outlines median wait times (in weeks) for national priority services. Table 2 outlines the percentage of women who receive regular breast and cervical screening.
TABLE 1. MEDIAN WAIT TIME (IN WEEKS) FOR SERVICES.
Indicator -- Median* Wait Time** (in weeks) from Booking Time to End of Service (or the first treatment in a series of treatments)
Cancer:
Wait time for Curative Radiation Therapy -- 2 weeks
Joint Replacement:
Wait time for Hip Replacement -- 17 weeks
Wait time for Knee Replacement -- 24 weeks
Diagnostic Imaging*:
Wait time for Magnetic Resonance Imaging (MRI) Scans -- 1 week (urgent), 15 weeks (routine)
Wait time for Computed Tomography (CT) Scans -- 1 week (urgent), 10 weeks (routine)
Sight Restoration:
Wait time for Cataract Surgery -- 21 weeks
*Median Wait Time: Of all people who have had their surgery/service between January 1, 2005 and June 30, 2005, half will have waited less than the median wait time. The other half of people on the wait list have waited more than the median wait time. The period of time studied for MRI and CT was June to December 2005.
**Wait Time: A wait time begins with the booking of a service, when the patient and the appropriate physician agree to a service and the patient is ready to receive it. The appropriate physician is the one with authority to determine the needed service and is not necessarily the patient’s family physician. A wait time ends with the commencement of the service.
TABLE 2. PERCENTAGE OF SCREENING.
Indicator -- Percent (%)
Diagnostic Imaging:
Percentage of women aged 50-69 years who have received Breast Cancer Screening every two years -- 61%
Percentage of women aged 18 to 69 years who have received Cervical Cancer Screening every three years after two normal test -- 58%
Note: The indicators in Table 2 are not directly related to wait times. Wait times may partially account for the reason that women have not received their screening within two years. However, other factors may be involved, including personal choice not to have the screening.
BACKGROUNDER II
A System that Meets the Priority Needs of the Citizens
PEI Department of Health
December 2005
Wait Times Are a Priority Across Canada:
In September 2004, the First Ministers agreed that access to timely care across Canada was their biggest concern and a national priority. As part of A 10-Year Plan to Strengthen Health Care, all governments agreed to work collaboratively in “Reducing Wait Times and Improving Access.”
All jurisdictions have taken concrete steps to address wait times. Building on this, First Ministers commit to achieve meaningful reductions in wait times in priority areas such as cancer, heart, diagnostic imaging, joint replacements, and sight restoration by March 31, 2007, recognizing the different starting points, priorities, and strategies across jurisdictions.
This report sets the stage to meet the priority needs of its citizens by improving access to services in PEI, along with a commitment to work with health providers to implement changes to wait list management. Work has already begun to (i) understand the current state of wait times in PEI, (ii) develop meaningful access targets and benchmarks comparable across Canada, and (iii) explore strategies and mechanisms that will enable the citizens of PEI to have improved access to services that meet national targets and benchmarks in these five priority areas.
Over the next few years, governments will work together towards meeting national evidence-based benchmarks and improving access to service in priority areas and to ensure quality care for all citizens. First Ministers agree to collect and provide meaningful information to its citizens on progress made in reducing wait times, as follows:
• each jurisdiction agrees to establish comparable indicators of access to health care professionals, diagnostic and treatment procedures with a report to their citizens to be developed by December 31, 2005.
• evidence-based benchmarks for medically acceptable wait times starting with cancer, heart, diagnostic imaging procedures, joint replacements, and sight restoration will be established by December 31, 2005 through a process to be developed by Federal, Provincial and Territorial Ministers of Health.
• multi-year targets to achieve priority benchmarks will be established by December 31, 2007.
• report annually to their citizens on the progress in meeting their multi-year wait time targets.
Where there is little or no scientific evidence to support the development of benchmarks, we will work to establish access targets for a number of key areas.
To continue to improve access and reach targets, supportive process changes will have to occur. This will involve improvements in information technology, reallocation of resources, and the implementation of mechanisms and processes to support the management of patient wait lists.
As we continue to work collaboratively with the other provinces and territories, we have agreed to national principles and processes that will improve the way that wait times are monitored, measured and managed.
Wait Time Access Targets Versus Evidence-based Benchmarks:
Wait time access targets and benchmarks are goals that each province and territory will strive to meet along side other priorities aimed at providing quality care to Canadians.
Although access targets and benchmarks for wait times are the standard of care that a high quality heath care system strives for, there is a clear distinction in how each is developed and applied. Benchmarks are the amount of time that the scientific evidence shows is appropriate to wait for a particular procedure.
For a variety of reasons, research in particular areas is not always available, therefore, benchmarks cannot be set. In absence of evidence to establish benchmarks, access targets can be developed using sound clinical advice and expert opinion. This information is generally gathered from clinical knowledge and experience of physicians and surgeons, health organizations, and researchers. As more research is explored, or when expert opinion changes, access targets can be adjusted to better reflect the appropriate wait times for services.
Access targets and benchmarks must be developed in conjunction with criteria, including patient characteristics, urgency, and health status at diagnosis. For some of the targets already established, urgency or priority categories have been identified. Further work is needed to define such criteria and how to employ it systematically across jurisdictions.
Defining wait times:
To measure a wait time – you need to know when the clock starts and stops. Provinces and territories agree to the following definitions (which are taken from the Provincial/Territorial Proposal to Establish Comparable Indicators of Access):
• Waiting for a health service begins with the booking date of the treatment or service.
• Waiting for a service ends when the patient receives the service, or the initial service in a series of treatments or services.
• A wait time is the number of days between the booking date and the finish date.
What Evidence Do We Currently Have to Establish Benchmarks?
Benchmarks must be developed using evidence from credible, peer-reviewed research. The Canadian Institutes of Health Research (CIHR) embarked on a comprehensive review of research to establish evidence-based research benchmarks for three of the five service areas and recently released the “Toward Canadian Benchmarks for Health Services Wait Times” report. They intend to explore research studies in the other two priority areas and will work with the provinces and territories to develop benchmarks where acceptable evidence exists.
The research teams synthesized Canadian and international evidence from best available research studies to answer two questions: (i) what does existing research say about the relationship between clinical condition, wait times and health outcomes or quality of life for individuals waiting for treatment; and (ii) what are the national and international wait times benchmarks (proposed or in use) for treatment, and what research evidence (if any) are they based on.
They gathered research regarding the relationship between patient characteristics, health service wait times and health outcomes. They concluded that there is generally not a lot of scientific evidence quantifying these relationships, and the nature and amount of evidence varies considerably across different clinical areas. As further research evidence becomes available, it will be used to develop new benchmarks or refine existing ones.
Nationally, access targets will have to be developed where not enough evidence exists to establish a benchmark. This process will need to involve physicians and surgeons, other health professionals, and health system staff. Access targets must also reflect patient characteristics, urgency and current health status. Following is a list of the benchmarks and access targets currently available.
TABLE 1. ESTABLISHED EVIDENCE-BASED BENCHMARKS FOR THE PRIORITY AREAS
Comparable Indicator -- Benchmark
Cancer:
Curative radiation therapy -- within 4 weeks of being ready to treat
Heart Surgery:
Coronary artery bypass graft (CABG) -- Level I within 2 weeks; Level II within 6 weeks; Level III within 26 weeks
Joint Replacement:
Hip fracture fixation -- within 48 hours
Hip replacement -- within 6 months
Knee replacement -- within 6 months
Diagnostic Imaging:
Breast cancer screening -- women aged 5 to 69 years every two years
Cervical cancer screening -- women aged 18 to 69 every three years after two normal tests
Sight Restoration:
Cataract surgery -- within 4 months for patients who have cataracts that significantly impair ability to function without assistance
In the coming months and years, the PEI health system, in collaboration with physicians, surgeons and other health professionals, will continue to work on the development of other access targets for the indicators identified in each of the priority areas.
Managing Wait Times:
Various benchmarks and access targets need to be established for the various categories of urgency or priority. This will ensure that the most urgent cases do not end up waiting longer periods of times for the service. Currently, there are no standards to determine when and under what circumstances a patient should be placed on a waiting list. Wait lists and priority rankings should be linked to clinical management systems that are monitored regularly, focused on ensuring that patients on lists are (i) waiting for care that is appropriate to their clinical circumstance, (ii) placed on a list based on urgency or priority, and (iii) monitored for changes in condition that would warrant a change of placement on the list.
Just as a wait list for a specific service (i.e., cancer surgery) must be managed based on urgency, wait lists amongst services must be well managed. This involves managing operating room time for various specialties. For example, consider two separate patients, one needing surgery for a hip replacement and the other needing surgery for cancer. If the patient needing the hip replacement is put on the wait list one month before the patient scheduled for cancer surgery, the cancer surgery patient should take priority over the hip replacement patient, as long as the benchmark for the hip replacement patient is not exceeded.
Management of wait lists is one of the most important determinants of reducing wait times. The PEI health system has begun to explore options to manage its wait lists for both national and provincial priorities. Physician and surgeon involvement will be key in developing a meaningful and useful management system. Currently, our ability to capture wait times information is negatively impacted by limited electronic information systems. We have various electronic information systems but they do not have the capability to communicate with each other to capture information that will be used to manage wait times. We will be building upon our current electronic systems, including the Common Client Registry, and two diagnostic imaging systems, Radiology Information System (RIS) and Picture Archiving Communication System (PACS). These systems, together with our planned Clinical Information System (CIS), will gather and manage patient information for hospital services. This new technology, along with existing technology, will be key in supporting mechanisms and processes that will collect, measure and manage wait lists.
Continued Commitment to Improving Access:
The PEI health system is committed to improving access to services that are priority to its citizens. We have embarked on a process to better understand wait times in PEI, develop multi-year targets that we need to strive for and to implement systems to appropriately manage wait lists. In the upcoming months and years, we will continue to gather more information on wait time access targets and benchmarks and understand what other provinces are doing to manage their wait lists. We will engage physicians and other health care providers in discussion on how best to manage and improve wait times, and implement a system that will meet the needs of its citizens.