Wait Time for All Other Elective Surgeries Combined Full data definition sign-off completed. Name of Measure Name of Measure (short) Domain Type of Measure Business Context Wait Time for All Other Elective Surgeries Combined: 90th Percentile Wait Time (in weeks) from date of decision to treat, to date of treatment. All Other Elective Surgeries Combined: 90 th Percentile Wait Time The wait time for all other elective surgeries combined is the 90 th percentile wait time (in weeks) from the date of decision to the date of treatment. 1 Quality of Health Services. Dimension of Quality: Accessibility. Process Measure This performance measure supports AHS and government accountability and reporting processes related to health system performance. For example: Rationale Notes for Interpretation Organizational Strategy Health and Wellness Ministry 2010-2013 Business Plan: Performance measure 5.g.: Wait time for all other elective surgical procedures: 90 th percentile wait time in weeks, as listed under Goal 5, Appropriate access to services across the continuum of care 3. Alberta Health Services 2010-2015 Health Plan. For annual reporting, the calculation uses data from patients served in the fiscal period April 1 to March 31. For AWR monthly reporting: Waitlisted cases completed between rolling 3 month period prior to current reporting month end. For quarterly reporting: Waitlisted cases completed during the reporting quarter: June 30, September 30, December 31, and March 31. Providing reasonable access to health service is a major objective and a defining attribute of the publicly funded health system. Longer waits affect health status and quality of life and result in more costly health services. This measure supports the strategy to reduce the wait time for surgical procedures. Benchmark Comparisons Goal of 14 weeks 4 for 2014/2015. Cited References: 1 Alberta Health and Wellness: User Manual - Alberta Waitlist Registry, Version 1.9, published 2008-12-08, pages 22-24. 2 Report Category (see Appendix) and CCI Code Listing 3 Health and Wellness 2010 to 2013 Ministry Business Plan, Alberta Health and Wellness (2010), page 9. 4 2010-2015 Health Plan: Improving Health for All Albertans, Alberta Health Services, page 33. Page 1 of 12
Technical Specifications Metric Preferred Display Format Numerator Inclusion Criteria for Numerator Exclusion Criteria for Numerator 90 th Percentile in Weeks 9.9 Number of days that patients with an elective surgery performed had waited, converted to weeks. Cases completed within rolling 3 months prior to the last day of reporting month. Record is an off list or archived event and was completed. Include in monthy wait time calculation indicator flag = Y COMPLEX_CASE indicator = Y WAITLIST_INTERVENTION_RCAT_ID = 7,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68 2 All urgency levels combined Scheduled follow-up indicator= Y Postponed = Y REASON_OFF_CODE = canc, altr, emer, patd Emergent: events where the procedure was performed as an emergency procedure. WAITLIST_INTERVENTION_RCAT_ID = 10 (hip), 11 (knee), 16 (CABG), 3 (cataract) * REASON_OFF_CODE = canc, altr, emer, patd (cancelled, done at alternate facility, emergency, patient death) Denominator Data Source(s) for Numerator Refresh Rate of Numerator Inclusion Criteria for Denominator Exclusion Criteria for Denominator Data Source(s) for Denominator Refresh Rate of Denominator Alberta Waitlist Registry (AWR) data in the AHW Business Intelligence Environment (BIE) Monthly Not applicable Not applicable Not applicable Not applicable Not applicable Page 2 of 12
Technical Notes A percentile is defined as a point on a rank-ordered scale, found by sorting a group of observations in order of magnitude from lowest to highest. The first percentile approximates the very lowest/bottom number found, while the 100th percentile is the very highest reported. The nth percentile is the point exceeding n percent of the observations. As follows, the 90th percentile wait time is the observed wait time that is equal to or greater than 90 percent of other observations. Each observation is the wait time in weeks, computed as: weeks_wait = (treatment date - decision date)/7, for each wait listed case recorded in the Alberta Waitlist Registry (AWR) meeting specified inclusion/exclusion criteria, completed within rolling 3 month period on or prior to the last day of the reporting period. Decision date is the date that the patient and surgeon decide upon a surgical intervention. If not available, then the date the facility received the service request (booking date) is used. 1 Treatment date is the date the surgical intervention took place, as indicated if Date Off is entered as a date later than decision date and DONE is entered in the Reason Off field. 1 Formula is L + ((H - L) * D) / 7 Example: Report contains 31 events. For 90 th percentile calculate 31 events *.9 resulting in 27.9. Using [L + ((H - L) * D)] / 7 Where: L = event 27, as the 27.9 value is rounded down. H = event 28; as the value 27.9 is rounded up. D = 0.9, as the digit in the 10 th decimal place of 27.9 If the days waited for event 27 equals 20 days waited and the days waited for event 28 equals 30 days, then: 20 + ((30-20) * 0.9) = 29 days. In order to determine the number of weeks waited, the result is divided by 7: 29 days / (7 days/week) = 4.14 weeks If the 90th percentile of a variable is a whole number (no decimal value for (D)), then the value of (H) and (L) will be the same: Example: Report contains 30 events 90 th percentile of 30 events = 30*(0.9) = 27 [27 + ((27-27)*0)] / 7 = 6.75 weeks Page 3 of 12
Calculation AWR Calculation: L + ((H - L) * D) / 7 For a set of measurements arranged in order of magnitude, the pth, in this case, 90th percentile is the value that has p, or 90 percent of the measurements below it and (100-p), or 10 percent above it. AHW SAS code for calculation of percentile is as follows: The 90 th percentile statistic is obtained by use of a SAS module PROC MEANS, to produce simple univariate descriptive statistics for numerical variables. The BY variable in this case is WAITLIST_INTERVENTION_RCAT_ID=<inclusion criteria>, and the numerical variable is weeks_wait, which is the calculated wait time for each observation. The selected SAS output statistic for 90 th percentile is P90. rsubmit; data AWRBIE_SELECT_INTV_FY; set ods_prod.detailed_waitlist_event_awr_v_i2; start_date = '01Apr2009:0:0:0'dt; end_date = '31Mar2010:0:0:0'dt; weeks_wait=days_waited/7; data AWRBIE_SELECT_INTV; set AWRBIE_SELECT_INTV_FY; if date_off ge start_date and date_off le end_date and INCLUDE_IN_MWT_IND EQ 'Y' and SCHEDULED_FOLLOWUP_IND ne 'Y' And COMPLEX_CASE eq Y AND INTERVENTION_POSTPONED_IND NE 'Y' and ( MISSING(DECEASED_DT) OR DECEASED_DT gt end_date ) and (WAITLIST_INTERVENTION_RCAT_ID eq <inclusion criteria> ; data AWRBIE_SELECT_INTV_FY; set AWRBIE_SELECT_INTV AWRBIE_SELECT_INTV; proc sort data=awrbie_select_intv_fy; by REPORT_CATEGORY_ID weeks_wait; PROC MEANS DATA=AWRBIE_SELECT_INTV_FY; Relationship to Other Indicators BY REPORT_CATEGORY_ID; VAR weeks_wait; ID REPORT_CATEGORY_ID; OUTPUT OUT=AR_FY_WT_STATS p90=wt90th; title 'AWR 90th Percentile Wait Times for All Other Elective Surgeries Combined'; proc print; run; endrsubmit; Page 4 of 12
Level of Reporting Frequency of Reporting Limitations Provincial Zone Facility Level of Care Physician Name Urgency Code Annually, Quarterly, Monthly The quality of data available from Alberta Health Services for Alberta Waitlist Registry may limit reporting on this measure. The calculation for wait times is from Decision Date to the date surgery was completed. This indicator does not measure the entire wait time from a patient perspective. The wait time between referral from a family practitioner to the time seen by a specialist is not measured. The BIE data is updated the first Saturday evening following the monthly AWR ETL (Extract/Transform/Load) on the 21 st of every month. Page 5 of 12
Appendix: AWR Report Categories REPORT COMMON NAME OVERVIEW CATEGORY ID 7 Gall Bladder Removal Gall bladder removal surgery (cholecystectomy) is the removal of the gall bladder performed by general surgeons. 22 Interventions on the Brain and Spinal Cord Interventions on the brain and spinal cord are performed by neurosurgeons. This category includes interventions on the brain, spinal cord, spinal canal, meninges, dura mater of the brain, ventricles of the brain, thalamus, basal ganglia, pituitary and cerebellum as inpatient surgery by a neurosurgeon or other surgeon. 23 Carpal tunnel release Carpal tunnel release relieves the pressure on the median nerve (a nerve that runs through the wrist and into the hand). Carpal tunnel release surgery is usually done as outpatient day surgery by a plastic surgeons, neurosurgeons or orthopaedic surgeons. 24 Other interventions on the nerves on the nerves that were not covered by any other category. This includes repairs, excisions, destruction, implantation or release of nerves and related devices. These procedures are done as outpatient or inpatient surgery by a neurosurgeon or other surgeon. 25 Interventions on the eyelid Interventions on the eyelid represent therapeutic interventions or surgical procedures that include repairs, excisions, construction, reconstruction, or biopsy of the eyelid. These procedures are done as outpatient or inpatient surgery by ophthalmology surgeon or other surgeon. 26 Other interventions on the eye on the eye that were not covered by any other category. This includes repairs, excisions, construction, reconstruction, implantation or removal of devices, or biopsy of the eye. These procedures are done as outpatient or inpatient surgery by ophthalmology surgeon, plastic surgeon or other surgeon. 27 Tubes in the ears Tubes in the ears represent therapeutic interventions or surgical procedures that include implantation or removal of tube in the tympanic membrane, ear. These procedures are done as outpatient or inpatient surgery by otolaryngology (ear, nose and throat) surgeon or other surgeon or physician. 28 Other Interventions on the ear 29 Interventions on the nose and nasal cartilage on the ear that were not covered by any other category. This includes inspection, repairs, excisions, construction, reconstruction, closure, drainage, implantation or removal of devices, or biopsy of external or internal ear. These procedures are done as outpatient or inpatient surgery by otolaryngology (ear, nose and throat) surgeon, plastic surgeon or other surgeon. that include repairs, excisions, construction, reconstruction, closure, drainage, implantation or removal of devices, or biopsy of the cartilage of the nose. These procedures are done as outpatient or inpatient surgery by otolaryngology (ear, nose and throat) surgeon, plastic surgeon or other surgeon. Page 6 of 12
Appendix: AWR Report Categories (continued) REPORT COMMON NAME CATEGORY ID 30 Other: head, nasal cavity and sinuses OVERVIEW on the head, nasal cavity or sinuses that were not covered by any other category. This includes repairs, excisions, construction, reconstruction, closure, drainage, fixation, implantation or removal of devices, or biopsy of head, nasal cavity and sinuses. These procedures are done as outpatient or inpatient surgery by otolaryngology (ear, nose and throat) surgeon, plastic surgeon or other surgeon. 31 Tonsillectomy A tonsillectomy is a therapeutic interventions or surgical procedures that includes the partial or total removal of tonsils (tonsillectomy) or adenoids (adenoidectomy) as outpatient surgery by an otolaryngology (ear, nose and throat) surgeon or other surgeon. 32 Other interventions on the mouth and throat 33 Interventions on the respiratory system This category represents therapeutic or surgical interventions on the mouth or throat not covered by other categories. This includes inspection, repairs, excisions, construction, reconstruction, closure, drainage, implantation or removal of devices, or biopsy of mouth, tonsils, oro- or nasofarinx, soft palate, tongue, salivary glands, gum, uvula, thyroid and parathyroid glands. These procedures are done as outpatient or inpatient surgery by an otolaryngology (ear, nose and throat) surgeon or other surgeon. that include inspection, repairs, excisions, construction, reconstruction, closure, drainage, implantation or removal of devices, or biopsy of glottis, larynx, trachea, lung, pleura, mediastinum and diaphragm. These procedures are done as inpatient surgery by cardiovascular surgeons. 34 Heart valve surgery that include inspection, repairs, excisions, construction, reconstruction, or biopsy of the heart valves. These procedures are done as inpatient surgery by a cardiovascular surgeon. 35 Implantation of pacemaker and other devices that include inspection or implantation of pacemakers or other devices. These procedures are done as inpatient surgery by a cardiovascular surgeon. 36 Other: heart and related structures 37 Interventions on the primary blood vessels 38 Other: upper body blood vessels on the heart or related structure that were not covered by any other category. This includes inspection, repairs, excisions, construction, reconstruction, drainage, bypass or biopsy of pericardium, myocardium (inter-arterial and inter-ventricular septum), aorta or pulmonary artery. These procedures are done as inpatient surgery by a cardiovascular surgeon. that include inspection, repairs, excisions, transfer, dilatation, occlusion, implantation of devices or biopsy of aorta, pulmonary artery, coronary artery or vena cava. These procedures are done as inpatient surgery by a cardiovascular or thoracic surgeon. on the upper blood vessels that were not covered by any other category. This includes inspection, repairs, excisions, reattachment, transfer, dilatation, occlusion, closure, implantation of devices or biopsy of carotid artery, intracranial vessels or other vessels on the upper body. These procedures are done as inpatient surgery by a cardiovascular or other surgeon. Page 7 of 12
Appendix: AWR Report Categories (continued) REPORT COMMON NAME OVERVIEW CATEGORY ID 39 Varicose vein (leg) surgery that include inspection, repairs, excisions, reattachment, transfer, dilatation, occlusion, closure, biopsy of varicose veins. These procedures are done as outpatient or inpatient surgery by a cardiovascular, plastic or other surgeon. 40 Other: lower body blood vessels 41 Interventions on lymph nodes 42 Intervention on the small intestine 43 Interventions on the large intestine 44 Interventions on the stomach 45 Other interventions on the digestive system 46 Other: liver, spleen, pancreas and gall bladder on the lower blood vessels that were not covered by any other category. This includes inspection, repairs, excisions, reattachment, bypass, transfer, dilatation, occlusion, closure, implantation of devices or biopsy of vessels on the lower body. These procedures are done as inpatient surgery by a cardiovascular, plastic or other surgeon. that include inspection, excisions or biopsy of lymph nodes. These procedures are done as outpatient surgery by a general surgeon or other physician. that include inspection, repairs, excisions, reattachment, construction, bypass, implantation of devices or biopsy of the small intestine. These procedures are done as inpatient surgery by a general or other surgeon. that include inspection, repairs, excisions, dilatation, fixation, reattachment, construction, bypass, implantation of devices or biopsy of the large intestine. These procedures are done as inpatient surgery by a general or other surgeon. that include inspection, repairs, excisions, dilatation, fixation, reattachment, construction, closure, bypass, implantation of devices or biopsy of the stomach. These procedures are done as inpatient surgery by a general or other surgeon. on the digestive system that were not covered by any other category. This includes inspection, repairs, excisions, drainage, reattachment, construction, closure, bypass, control of bleeding, implantation or remove of devices or foreign bodies, or biopsy of the digestive system (esophagus, pylorus, small or large intestine, rectum, anus, appendix). These procedures are done as inpatient surgery by a general or other surgeon. on the liver, spleen, pancreas, gallbladder or bile ducts that were not covered by any other category. This includes inspection, repairs, excisions, drainage, construction, closure, bypass, control of bleeding, implantation or remove of devices or foreign bodies, transplant or biopsy of the liver, spleen, pancreas, gall bladder or bile ducts. These procedures are done as inpatient surgery by a general or other surgeon. Page 8 of 12
Appendix: AWR Report Categories (continued) REPORT COMMON NAME CATEGORY ID 47 Interventions on the urinary bladder 48 Interventions on the urinary system OVERVIEW that include inspection, repairs, excisions, drainage, construction, closure, fixation, drainage, control of bleeding, implantation or remove of devices or foreign bodies, or biopsy of urinary bladder. These procedures are done as inpatient surgery by urologist or general surgeon. that include inspection, repairs, excisions, drainage, construction, closure, fixation, drainage, control of bleeding, dilatation, bypass, implantation or remove of devices or foreign bodies, procurement and transplant or biopsy of urinary system (kidney, urethra) and adrenal gland. These procedures are done as inpatient surgery by urologist or other surgeon. 49 Prostate Surgery that include inspection, repairs, excisions (radical, partial or total), drainage, fixation, drainage, control of bleeding, dilatation, implantation or remove of devices or foreign bodies, or biopsy of the prostate. These procedures are done as inpatient surgery by urologist or other surgeon. 50 Other interventions on the male genital system 51 Tubal Ligation for sterilization This category represents therapeutic or surgical interventions on the male genital system not covered by other categories. This includes inspection, repairs, excisions (radical, partial or total), drainage, fixation, control bleeding, dilatation, occlusion, implantation/removal of device or foreign body, or biopsy of the male genital system (prepuce, penis, scrotum, testis, vas deferens, spermatic cord, prostate) done as inpatient or outpatient surgery by urologist or other surgeon. that include inspection, occlusion, destruction or ligation for sterilization of the fallopian tube. These procedures are done as inpatient or outpatient surgery by gynaecologist or other surgeon. 52 Hysterectomy that include inspection, excision (partial, radical or total (hysterectomy)) of the uterus and surrounding structures. These procedures are done as inpatient surgery by gynaecologist or other surgeon. 53 Interventions on the vagina that include inspection, repairs, excision, drainage, fixation, brachytherapy, drainage, control of bleeding, dilatation, occlusion, closure, release, fixation, implantation or remove of devices or foreign bodies, or biopsy of the vagina. These procedures are done as inpatient or outpatient surgery by gynaecologist, urologist or other surgeon. 54 Other interventions on the female genital tract This category represents therapeutic or surgical interventions on the female genital tract not covered by other categories; including inspection, repair, excision, drainage, fixation, brachytherapy, control bleeding, dilatation, occlusion, closure, release, construction/reconstruction, implantation/removal of device or foreign body, or biopsy of (vagina, uterus and surrounding structure, cervix, fallopian tube, ovary, vulva, perineum) as inpatient/outpatient by gynaecologist, urologist or other surgeon. 55 Hernia Repair that include inspection or repair of a hernia. These procedures are done as inpatient and outpatient surgery by a general or other surgeon. Page 9 of 12
Appendix: AWR Report Categories (continued) REPORT COMMON NAME CATEGORY ID 56 Spinal vertebrae, discs and muscles of back OVERVIEW that include inspection, repairs, excision, fusion, fixation, implantation or remove of devices, or biopsy of the spinal vertebrae and muscle of the back. These procedures are done as inpatient or outpatient surgery by a neurosurgeon, orthopedic surgeon or general surgeon. 57 Muscles and bones of the truck and pelvis 58 Interventions on the shoulder 59 Interventions on the arm and elbow 60 Interventions on the hand and wrist that include inspection, repairs, excision, removal, fusion, fixation, amputation, destruction, drainage, construction or reconstruction, implantation or remove of devices, or biopsy of the muscle and bones of the trunk and pelvis. These procedures are done as inpatient or outpatient surgery by a orthopedic surgeon or general surgeon. that include inspection, repairs, excision, removal, fusion, fixation, amputation, destruction, drainage, construction or reconstruction, implantation or remove of devices, or biopsy of the muscle and bones of the shoulder. These procedures are done as inpatient or outpatient surgery by a orthopedic surgeon or general surgeon. that include inspection, repairs, excision, removal, fusion, fixation, amputation, destruction, drainage, construction or reconstruction, implantation or remove of devices, or biopsy of the muscle and bones of the arm and elbow. These procedures are done as inpatient or outpatient surgery by a orthopedic surgeon or general surgeon. that include inspection, repairs, excision, removal, fusion, fixation, amputation, destruction, drainage, construction or reconstruction, implantation or remove of devices, or biopsy of the muscle and bones of the hand and wrist. These procedures are done as inpatient or outpatient surgery by a orthopedic surgeon, plastic surgeon or general surgeon. 61 Knee arthroscopy that include inspection (arthroscopy) of the knee. These procedures are done as outpatient surgery by a orthopedic, plastic or general surgeon as well as some specialized physicians 62 Intervention on the lower leg that include inspection, repairs, excision (partial, radical or total), removal, fixation, amputation, destruction, drainage, construction or reconstruction, implantation or remove of devices, or biopsy of the muscle and bones of the lower leg. These procedures are done as inpatient or outpatient surgery by orthopedic or other surgeon. 63 Other interventions on the hip and thigh on the hip and thigh that were not covered by any other category. This includes inspection, repairs, excision, removal, fixation, amputation, destruction, drainage, construction or reconstruction, release, fusion, immobilization, implantation or remove of devices, or biopsy of the muscle, joint and bones of the hip and thigh. These procedures are done as inpatient or outpatient surgery by orthopedic or other surgeon. Page 10 of 12
Appendix: AWR Report Categories (continued) REPORT COMMON NAME CATEGORY ID 64 Other interventions on the knee 65 Interventions on the ankle and foot 66 Mastectomy: removal of breast 67 Other interventions on the breast 68 Therapeutic interventions on the skin OVERVIEW on the knee that were not covered by other categories. These include inspection, repairs, excision, removal, fixation, amputation, destruction, drainage, construction or reconstruction, release, fusion, immobilization, implantation or remove of devices, or biopsy of the knee. These procedures are done as inpatient or outpatient surgery by orthopedic or other surgeon. that include inspection, repairs, excision, removal, fixation, amputation, destruction, reduction, drainage, construction or reconstruction, release, fusion, immobilization, implantation or remove of devices, or biopsy of the ankle and foot. These procedures are done as inpatient or outpatient surgery by orthopedic or other surgeon. that include inspection or excision (partial, radical, total (mastectomy)) of the breast. These procedures are done as inpatient surgery by gynaecologist, oncologist or other surgeon. on the breast that were not covered by any other category. This includes inspection, repairs, excision, drainage, fixation, fixation, construction or reconstruction, implantation or remove of devices or foreign bodies, or biopsy of the breast. These procedures are done as inpatient or outpatient surgery by gynaecologist, urologist or other surgeon. that include inspection, repairs, excision, dressing, drainage, fixation, construction or reconstruction, implantation or remove of devices or foreign bodies, or biopsy of the skin. These procedures are done as inpatient or outpatient surgery by a plastic surgeon or dermatologist. Page 11 of 12
Document Version History Version Version Date Summary of Changes 1.0 May 18, 2010 Final version for initial use. 1.1 July 13, 2010 Initial measure. 1.2 July 21, 2010 Revisions. 1.3 July 28, 2010 Update Key Contact and Executive Lead, minor modifications. 2.0 Version ready for signoff. 2.1 September 14, 2010 Full data definition signoff completed. Page 12 of 12