Vancouver Coastal Health – Value and Limitations in Hospital Utilization and Expenditure (VALHUE) Project Summary
Significance and Policy Context
There is little understanding of whether shorter wait times are associated with better clinical outcomes, and whether policy-linked initiatives to increase access to surgery are associated with consistent changes in health improvement. The literature regarding the effect of wait times on health is significantly under-developed. VALHUE aims to address this gap in the literature.
This study is intended to inform clinicians, VCH decision makers, and policymakers about the nature of relationships between wait times and trajectory of change in health status, pain and depression. We expect that the results will be immediately relevant in BC and other provinces implementing changes to prioritizing health expenditures. This study is the first in Canada to examine the trajectory of patients’ health while on the wait list, and also to differentiate the impact of surgical care by different types of conditions.
Funded by the Canadian Institutes for Health Research (CIHR), VALHUE is a significant PROMS project within VCH that began in January 2012. Current funding for this project ends September 2014.
Objective and Specific Aims
This joint project with the University of British Columbia aims to quantify the association between time spent on the surgical waitlist and health status. This is to be evaluated by measuring changes in health status for those patients undergoing selected surgical procedures.
The VALHUE project uses validated Patient Reported Outcome instruments to measure change in general health status, acute and chronic pain, and depression while waiting for care and after surgical treatment. This study will fill an important gap in the current understanding on the effects that changes in wait times and surgical volumes have on patients’ health.
VALHUE has two specific aims:
Aim 1: Surveying patients twice prior to surgery, we will test for changes in patients’ health while on the surgical wait list.
Aim 2: Surveying patients pre- and post-surgery, we will test for changes in patients’ health as a result of wait times.
Methods
This project consists of both a quality assurance component and a research component. VCH is responsible for collecting the survey data for a number of elective surgical procedures as part of a quality assurance project.
Registered patients are contacted regarding their interest in participating and, after obtaining consent, a sequence of surveys are administered to each participant, including: 1) a generic health status questionnaire (EQ-5D), 2) a pain questionnaire (PEG), 3) a depression assessment (PHQ-9), and 4) a condition-specific questionnaire. Patients are surveyed soon after being booked on the waitlist registry, approximately two weeks before surgery, and approximately six months after surgery. Survey data will be linked to Discharge Abstract Database (DAD), ED, and ADTC, in order to include other outcome data, such as discharge disposition, readmissions, time on waitlist, and expected cost. VCH will de-identify the data and transfer it to UBC for research and analysis purposes.
Analysis
Surveying patients twice before surgery, we will test for changes in patients’ health while on the surgical waitlist. Time series analysis will be our primary statistical tool in analyzing patient’s change in health status prior to surgery. We will construct time series models for each surgery to examine the change in health status controlling for structural variables such as hospital, (anonymous) surgeon and patient characteristics.
Surveying patients pre- and post-surgery, we will test for changes in patients’ health as a result of wait times. We will use time series methods to examine the change in health status pre- and post-surgery as measured by the EQ-5D adjusting for hospital, surgeon and patient effects. The hospital and surgeon effects will be incorporated into the model. We will create a separate time series model for each surgery.
We will take a similar approach to measuring pain and depression while on the wait list for surgery.
While we will take every effort to minimize participant drop-out, some participants will not complete all surveys and some data will be missing (incomplete). We will adjust the models for missing data when required. Although the instruments are previously validated, we will also examine the data to detect whether the data are affected by “floor” or “ceiling” effects.
Products
For VCH, regular analytical reports will be generated which provide a comprehensive profile of patients’ health status, pain and depression while waiting for surgery. These timely reports will be shared with Vancouver Coastal Health and Providence Health Care sites via Decision Support and/or the Regional Surgical Executive Council (RSEC). We are in the process of determining the specific contents, format, and frequency of the reporting. It is possible that this information will provide invaluable insight into evaluating appropriateness of wait times for elective surgery.
For UBC researchers, and for the community at large, this study will provide insight into how patients’ health changes while waiting for surgery. In addition, the study will collect valuable information, and report on, changes in health attributable to surgery. It is expected that researchers and clinical collaborators will use the results to produce manuscripts for academic publications.
Parties involved:
Vancouver Coastal Health
University of British Columbia
Funding Source:
Canadian Institutes of Health Research
Project Period:
October 1, 2011 to September 30, 2014
Geographic Scope:
Health Authority
Six hospitals
Patient Population:
Adult patients waitlisted for one of selected surgical procedures
Clinical Area(s):
Otolaryngology
General Surgery
Gynecology
Plastic
Neurosurgery
Orthopedic
Urology
Contact:
Jason Sutherland
Principal Investigator, UBC
jsutherland@chspr.ubc.ca
Angie Chan
Project Manager, VALHUE
Angie.Chan2@vch.ca
(604) 714-3771 ext 2308