Abstract
Currently, the median waiting time for total hip and knee replacement in Ontario is greater than 6 months. Waiting longer than 6 months is not recommended and may result in lower post-operative benefits. We developed a simulation model to estimate the proportion of patients who would receive surgery within the recommended waiting time for surgery over a 10-year period considering a wide range of demand projections and varying the number of available surgeries. Using an estimate that demand will grow by approximately 8.7% each year for 10 years, we determined that increasing available supply by 10% each year was unable to maintain the status quo for 10 years. Reducing waiting times within 10 years required that the annual supply of surgeries increased by 12% or greater. Allocating surgeries across regions in proportion to each region’s waiting time resulted in a more efficient distribution of surgeries and a greater reduction in waiting times in the long-term compared to allocation strategies based only on the region’s population size.
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Harris WH, Sledge CB (1990) Total hip and total knee replacement (1). N Eng J Med 323(11):725–731
(2003) NIH consensus statement on total knee replacement. NIH Consensus State of the Science Statements. 20(1):1–32
Harris WH, Sledge CB (1990) Total hip and total knee replacement (2). N Eng J Med 323(12):801–807
Brauer CA, Rosen AB, Olchanski NV, Neumann PJ (2005) Cost–utility analyses in orthopaedic surgery. J Bone JT Surg [Am Vol] 87(6):1253–1259
Laupacis A, Bourne R, Rorabeck C, Feeny D, Wong C, Tugwell P, Leslie K, Bullas R (1994) Costs of elective total hip arthroplasty during the first year. Cemented versus noncemented. J Arthroplast 9(5):481–487
Lavernia CJ, Guzman JF, Gachupin-Garcia A (1997) Cost effectiveness and quality of life in knee arthroplasty. Clin Orthop Relat Res (345):134–139
Brunenberg DE, van Steyn MJ, Sluimer JC, Bekebrede LL, Bulstra SK, Joore MA (2005) Joint recovery programme versus usual care: an economic evaluation of a clinical pathway for joint replacement surgery. Med Care 43(10):1018–1026
Chang RW, Pellisier JM, Hazen GB (1996) A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. J Am Med Assoc 275(11):858–865
Blake JT (2005) Shooting arrows in the dark: the policies and practices of waitlist management in Canada. Clin Invest Med 28(6):308–311
Coyte PC, Wright JG, Hawker GA, Bombardier C, Dittus RS, Paul JE, Freund DA, Ho E (1994) Waiting times for knee-replacement surgery in the United States and Ontario. N Eng J Med 331(16):1068–10671
Health care professionals views on access to health care (2004) [cited 2006, February 14]; Available from: http://www.cma.ca/multimedia/staticcontent/CMA/Content_Images/Inside_cma/Better-Access/Ipsos-Polling.pdf
Chaoulli v. Quebec (Attorney General), 2005 scc35 (2005) 1 Supreme Court Reports 791
Williams JI, Shipton D, Badley EM, Hawker G, Kreder HJ, DeBoer D, Guan J, Mahomed N (2004) Surgical Services. In: Badley EM, Glazier R (eds) Arthritis and related conditions in Ontario: ICES research atlas. Institute for Clinical Evaluative Sciences, Toronto, ON
Esmail N, Walker M (2004) Waiting your turn: hospital waiting lists in Canada. 14th ed. Critical Issues Bulletin: Fraser Institute, Vancouver, BC
Noseworthy T, McGurran J, Hadorn D (2003) Waiting for scheduled services in Canada. J Eval Clin Pract 9(1):23–31
Bourne RB, DeBoer D, Hawker GA, Kreder HJ, Mahomed NN, Paterson JM, Warner S, Williams JI (2005) Chapter 5. Total hip and knee replacement. In: Tu JV et al (eds) Access to Health Services in Ontario: ICES Atlas. Institute for Clinical Evaluative Sciences, Toronto, ON
Bourne RB, DeBoer D, Hawker GA, Kreder HJ, Laupacis A, Mahomed NN, Paterson JM, Pinfold SP, Warner S, Williams JI (2006) Chapter 5. Total hip and knee replacement. In: Tu JV et al (eds) Access to Health Services in Ontario: ICES Atlas Update. Institute for Clinical Evaluative Sciences, Toronto, ON
Wait Time Alliance for Timely Access to Health Care (2005) It’s about time! Achieving benchmarks and best practices in wait time management. Canadian Medical Association, Ottawa, ON. Available from: http://www.waittimealliance.ca/multimedia/CMA/Content_Images/Inside_cma/Media_Release/pdf/2005/wta-final.pdf
First ever common benchmarks will allow Canadians to measure progress in reducing wait times. [Press Release, December 12, 2005] Available from: http://www.health.gov.on.ca/english/media/news_releases/archives/nr_05/nr_121205.html
Chesworth B, Warner S, Bourne R (2006) Guideline for wait time thresholds for total hip and knee replacement surgery based on severity: Detailed report. Ontario Joint Replacement Registry, London, ON
Gross AE (2005) Report of the total hip and knee joint replacement expert panel. Total Hip and Knee Joint Replacement Expert Panel. Available from: http://www.health.gov.on.ca/renouvellement/wait_timesf/wt_reportsf/hip_knee_ep_report_0905.pdf
Bunker JP, Frazier HS, Mosteller F (1994) Improving health: measuring effects of medical care. Milbank Q 72(2):225–258
(2003) Total Joint Replacements in Ontario: First Edition. Ontario Joint Replacement Registry, London, ON
Chesworth B, Warner S, Bourne R (2004) Total joint replacements in ontario: Annual Report 2004. Ontario Joint Replacement Registry, London, ON
Perruccio AV, Badley EM, Guan J (2004) Burden of disease. In: Badley EM, Glazier R (eds) Arthritis and related conditions in Ontario: ICES research atlas. Institute for Clinical Evaluative Sciences, Toronto, ON
(1994) NIH consensus statement on total hip replacement. NIH Consensus State of the Science Statements 12(5):1–31
Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, Badley EM (2000) Differences between men and women in the rate of use of hip and knee arthroplasty. N Eng J Med 342(14):1016–1022
Hawker GA (2004) The quest for explanations for race/ethnic disparity in rates of use of total joint arthroplasty. J Rheumatol 31(9):1683–1685
Hawker GA, Wright JG, Glazier RH, Coyte PC, Harvey B, Williams JI, Badley EM (2002) The effect of education and income on need and willingness to undergo total joint arthroplasty. Arthritis Rheum 46(12):3331–3339
Karlson EW, Mandl LA, Aweh GN, Sangha O, Liang MH, Grodstein F (2003) Total hip replacement due to osteoarthritis: the importance of age, obesity, and other modifiable risk factors. Am J Med 114(2):93–98
Gelber AC, Hochberg MC, Mead LA, Wang NY, Wigley FM, Klag MJ (1999) Body mass index in young men and the risk of subsequent knee and hip osteoarthritis. Am J Med 107(6):542–548
Jarvholm B, Lewold S, Malchau H, Vingard E (2005) Age, bodyweight, smoking habits and the risk of severe osteoarthritis in the hip and knee in men. Eur J Epidemiol 20(6):537–542
Katzmarzyk PT (2002) The Canadian obesity epidemic, 1985–1998. Can Med Assoc J 166(8):1039–1040
Katzmarzyk PT (2002) The Canadian obesity epidemic: an historical perspective. Obes Res 10(7):666–674
Dunbar MJ, Malloy L, Blake JT, Hennigar A, Storey J (2004) Department of surgery, wait list management project, orthopaedic pilot project. Queen Elizabeth II Health Sciences Center, Halifax, NS
Robertsson O, Dunbar MJ, Knutson K, Lidgren L (2000) Past incidence and future demand for knee arthroplasty in Sweden: a report from the Swedish Knee Arthroplasty Register regarding the effect of past and future population changes on the number of arthroplasties performed. Acta Orthop Scand 71(4):376–380
Brander VA, Malhotra S, Jet J, Heinemann AW, Stulberg SD (1997) Outcome of hip and knee arthroplasty in persons aged 80 years and older. Clin Orthop Relat Res (345):67–78
Derrett S, Paul C, Morris JM (1999) Waiting for elective surgery: effects on health-related quality of life. Int J Qual Health Care 11(1):47–57
Lillard LA, Rogowski J, Kington R (1999) Insurance coverage for prescription drugs: effects on use and expenditures in the Medicare population. Med Care 37(9):926–936
Kington R, Rogowski J, Lillard L (1995) Dental expenditures and insurance coverage among older adults. Gerontologist 35(4):436–443
Poisal JA, Chulis GS (2000) Medicare beneficiaries and drug coverage. Health Aff (Millwood) 19(2):248–256
Stuart B, Doshi JA, Briesacher B, Wrobel MV, Baysac F (2004) Impact of prescription coverage on hospital and physician costs: a case study of medicare beneficiaries with chronic obstructive pulmonary disease. Clin Ther 26(10):1688–1699
Coulson NE, Terza JV, Neslusan CA, Stuart BC (1995) Estimating the moral-hazard effect of supplemental medical insurance in the demand for prescription drugs by the elderly. Am Econ Rev 85(2):122–126
Poisal JA, Murray L (2001) Growing differences between Medicare beneficiaries with and without drug coverage. Health Aff (Millwood) 20(2):74–85
Cross MJ, March LM, Lapsley HM, Tribe KL, Brnabic AJ, Courtenay BG, Brooks PM (2000) Determinants of willingness to pay for hip and knee joint replacement surgery for osteoarthritis. Rheumatology 39(11):1242–1248
Hadley J, Cunningham PJ (2005) Perception, reality and health insurance: uninsured as likely as insured to perceive need for care but half as likely to get care. Issue Brief (Centre for Studying Health System Change) (100):1–5
Hawker GA, Wright JG, Badley EM, Coyte PC (2004) Perceptions of, and willingness to consider, total joint arthroplasty in a population-based cohort of individuals with disabling hip and knee arthritis. Arthritis Rheum 51(4):635–641
Bloom BS, Fendrick AM (1987) Waiting for care. Queuing and resource allocation. Med Care 25(2):131–139
Williams JI, Llewellyn Thomas H, Arshinoff R, Young N, Naylor CD (1997) The burden of waiting for hip and knee replacements in Ontario. Ontario Hip and Knee Replacement Project Team. J Eval Clin Pract 3(1):59–68
Rigge M (1994) Quality of life of long wait orthopaedic patients before and after admission: a consumer audit. Qual Health Care 3(3):159–163
Thomas S, Ord J, Pailthorpe C (2001) A study of waiting time for surgery in elderly patients with hip fracture and subsequent in-patient hospital stay. Ann R Coll Surg Engl 83(1):37–39
Mahon JL, Bourne RB, Rorabeck CH, Feeny DH, Stitt L, Webster-Bogaert S (2002) Health-related quality of life and mobility of patients awaiting elective total hip arthroplasty: a prospective study. Can Med Assoc J 167(10):1115–1121
Roy CW, Hunter J (1996) What happens to patients awaiting arthritis surgery? Disability and Rehabilitation 18(2):101–105
Ostendorf M, Buskens E, van Stel H, Schrijvers A, Marting L, Dhert W, Verbout A (2004) Waiting for total hip arthroplasty: avoidable loss in quality time and preventable deterioration. J Arthroplast 19(3):302–309
Rossvoll I, Benum P, Bredland TR, Solstad K, Arntzen E, Jorgensen S (1993) Incapacity for work in elective orthopaedic surgery: a study of occurrence and the probability of returning to work after treatment. J Epidemiol Community Health 47(5):388–394
Hertzman P, Johnsson R, Lindgren B (1988) Cost of sick leave for total hip replacement. Acta Orthop Scand 59(3):266–269
Johnsson R, Persson BM (1986) Occupation after hip replacement for arthrosis. Acta Orthop Scand 57(3):197–200
Hajat S, Fitzpatrick R, Morris R, Reeves B, Rigge M, Williams O, Murray D, Gregg P (2002) Does waiting for total hip replacement matter? Prospective cohort study. J Health Serv Res Policy 7(1):19–25
Health Canada: Wait times in Canada. [cited 2006, February 24]; Available from: http://www.hc-sc.gc.ca/hcs-sss/qual/acces/wait-attente/index_e.html
Kingman JFC (1962) On Queues in Heavy Traffic. J R Stat Soc, B (Methodological) 24(2):383–392
Kingman JFC (1962) Some inequalities for the queue GI/G/1. Biometrika 49(3/4):315–324
Kollerstrom J (1974) Heavy traffic theory for queues with several servers. I. J Appl Probab 11(3):544–552
Mazumdar S (1970) On priority queues in heavy traffic. J R Stat Soc, B (Methodological) 32(1):111–114
Iglehart DL, Whitt W (1970) Multiple channel queues in heavy traffic. I. Adv Appl Probab 2(1):150–177
Whitt W (1972) Complements to heavy traffic limit theorems for the GI/G/1 queue. J Appl Probab 9(1):185–191
Dagsvik J (1979) Stability and heavy traffic results for the general bulk queue. Adv Appl Probab 10(1):213–231
Bindman AB, Grumbach K, Keane D, Rauch L, Luce JM (1991) Consequences of queuing for care at a public hospital emergency department. J Am Med Assoc 266(8):1091–1096
Ben-Haim M, Carmiel M, Katz P, Shabtai E, Oren R, Nakache R (2006) Is the model of end-stage liver disease (MELD) valid in Israel? A critical analysis of liver transplant waiting list mortality. Israel Med Assoc J 8(9):605–609
Navarro V (1969) A systems approach to health planning. Health Serv Res 4(2):96–111
Navarro V (1969) Planning personal health services: a Markovian model. Med Care 7(3):242–249
Navarro V, Parker R, White K (1970) A stochastic and deterministic model of medical care utilization. Health Serv Res 5(4):342–357
France DJ, Levin S (2006) System complexity as a measure of safe capacity for the emergency department. Acad Emerg Med 13(11):1212–1219
Codrington-Virtue A, Whittlestone P, Kelly J, Chaussalet T (2005) An interactive framework for developing simulation models of hospital accident and emergency services. Stud Health Technol Inform 114:277–283
Gupta D, Natarajan MK, Gafni A, Wang L, Shilton D, Holder D, Yusuf S (2006) Capacity planning for cardiac catheterization: A case study. Health Policy, in press
Kaplan EH, Johri M (2000) Treatment on demand: an operational model. Health Care Manage Sci 3(3):171–183
Segev DL, Gentry SE, Melancon JK, Montgomery RA (2005) Characterization of waiting times in a simulation of kidney paired donation. American Journal of Transplantation 5(10):2448–2455
Thompson D, Waisanen L, Wolfe R, Merion RM, McCullough K, Rodgers A (2004) Simulating the allocation of organs for transplantation. Health Care Manage Sci 7(4):331–338
Bruni ME, Conforti D, Sicilia N, Trotta S (2006) A new organ transplantation location-allocation policy: a case study of Italy. Health Care Manage Sci 9(2):125–142
Su X, Zenios SA, Chertow GM (2004) Incorporating recipient choice in kidney transplantation. J Am Soc Nephrol 15(6):1656–1663
Worthington DJ (1987) Queueing models for hospital waiting lists. J Oper Res Soc 38(5):413–422
Smith-Daniels V, Schweikhart S, Smith-Daniels D (1988) Capacity management in health care services: review and further research directions. Decis Sci 19(4):889–918
Klein RW, Dittus RS, Roberts SD, Wilson JR (1993) Simulation modeling and health-care decision making. Med Decis Mak 13(4):347–354
Vissers JM (1998) Health care management modelling: a process perspective. Health Care Manage Sci 1(2):77–85
Jun J, Jacobson S, Swisher J (1999) Application of discrete-event simulation in health care clinics: a survey. J Oper Res Soc 50:109–123
Local Health Integration Networks. (2004) October 2004 [cited 2006, February 17]; Available from: http://www.health.gov.on.ca/transformation/lhin/100604/att_1_100604.pdf
Law AM, Kelton WD (1982) Simulation modeling and analysis. McGraw-Hill, New York
Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, Wilkins A, Badley EM (2001) Determining the need for hip and knee arthroplasty: the role of clinical severity and patients’ preferences. Med Care 39(3):206–216
Hawker GA (2005) Personal Communication
Arnett G, Hadorn DC (2003) Developing priority criteria for hip and knee replacement: results from the Western Canada Waiting List Project. Can J Surg 46(4):290–296
Noseworthy TW, McGurran JJ, Hadorn DC (2003) Waiting for scheduled services in Canada: development of priority-setting scoring systems. J Eval Clin Pract 9(1):23–31
Moving forward: final report. Western Canada Waiting List Project. Calgary, AB. Available from: http://www.wcwl.org/media/pdf/news/moving_forward/report.pdf
Rumble T, Kreder HJ (2005) Report of benchmarks for wait times. The National Standards Committee, Canadian Orthopaedic Association.
Report of the Provincial Wait Time Monitoring Project Steering Committee. (2004) [cited February 22, 2006]; Available from: http://www.gov.ns.ca/health/wait_times/full-Wait%20Time.pdf
Target Time Frames For Surgery. [cited 2006, February 22]; Available from: http://www.sasksurgery.ca/target_timeframes.htm
Noseworthy T, Sanmartin C, Bohm E, Conner-Spady B, DeCoster C, Dunbar M, Lorenzetti D, McLaren L, McGurran J (2005) Towards establishing evidence-based benchmarks for acceptable waiting times for joint replacement surgery. Canadian Institute for Health Research, Toronto, ON
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840
Ontario Population Projections 2004–2031. (2005) Ontario Ministry of Finance [cited 2006, February 8]; Available from: http://www.fin.gov.on.ca/english/demographics/demog05.html
Local health integration networks: geographic boundaries and supporting information. (2006) May 2006 [cited 2006, June 28]; Available from: http://www.health.gov.on.ca/transformation/lhin/lhinmap_mn.html
(2006) Health care renewal in Canada: clearing the road to quality. Health Council of Canada, Toronto, ON
(2005) 2005 CJRR report: total hip and knee replacements in Canada. Canadian Joint Replacement Registry. Canadian Institute for Health Information, Toronto, ON
Wait times in Ontario. February 6, 2006 [cited 2006, February 10]; Available from: http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html
Rumble T, Kreder HJ (2004) National Workforce & Services Report. The National Standards Committee of the Canadian Orthopaedic Association.
Shipton D, Badley EM, Mahomed NN (2003) Critical shortage of orthopaedic services in Ontario, Canada. J Bone Jt Surg [Am Vol] 85-A(9):1710–1715
Byrick RJ, Craig D, Carli F (2002) A physician workforce planning model applied to Canadian anesthesiology: assessment of needs. Can J Anaesth 49(7):663–670
Craig D, Byrick R, Carli F (2002) A physician workforce planning model applied to Canadian anesthesiology: planning the future supply of anesthesiologists. Can J Anaesth 49(7):671–677
Engen DA, Morewood GH, Ghazar NJ, Ashbury T, VanDenKerkhof EG, Wang L (2005) A demand-based assessment of the Canadian anesthesia workforce—2002 through 2007. Can J Anaesth 52(1):18–25
O’Brien-Pallas L, Alksnis C, Wang S (2003) Bringing the future into focus: projecting RN retirement in Canada. Canadian Institute for Health Information, Toronto, ON
Aiono S, Faber RG, Galland RB (2000) Surgeons have little control over general surgical waiting lists. Ann R Coll Surg of Engl 82(9 Suppl):304–307
Hurst J, Siciliani L (2003) OECD Health Working Papers No. 6: Tackling excessive waiting times for elective surgery: a comparison of policies in twelve OECD countries. Directorate for Employment, Labour, and Social Affairs, Paris
Wright JG, Hawker GA, Bombardier C, Croxford R, Dittus RS, Freund DA, Coyte PC (1999) Physician enthusiasm as an explanation for area variation in the utilization of knee replacement surgery. Med Care 37(9):946–956
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This project was funded by the Ontario Ministry of Health and Long Term Care through the Ontario Joint Replacement Registry (OJRR), hosted by the London Health Sciences Centre. LEC, CKA, and GSZ were also supported by the Natural Science and Engineering Research Council of Canada (NSERC).
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Cipriano, L.E., Chesworth, B.M., Anderson, C.K. et al. Predicting joint replacement waiting times. Health Care Manage Sci 10, 195–215 (2007). https://doi.org/10.1007/s10729-007-9013-z
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DOI: https://doi.org/10.1007/s10729-007-9013-z