Effect of single-entry referral models and team-based care on wait times for hip and knee joint replacement in Ontario: a simulation study.

Background: Long wait times for scheduled surgery are a major problem in Canadian health systems. We sought to determine the extent to which single-entry referral models (next available consultation), team-based care models (next available surgery regardless of consulting surgeon), or both could affect wait times for consultations and surgery.

Methods: We performed a discrete-event simulation study of wait times for consultations and surgeries for knee and hip joint replacement in Ontario's 5 postal regions using prospectively collected data on surgical wait times. We simulated the effects of coordinated referral models on the wait time for consultation (wait 1) and surgery (wait 2).

Results: Coordinated models led to larger reductions in high-outlier wait times (as reflected by the 90th percentile and the percentage of patients exceeding wait-time targets) than on median wait times when compared with the status quo. Single-entry referral models largely influenced wait 1, and team-based models of care affected only wait 2. Fully integrated models incorporating both single-entry referral and team-based care largely prevented patients from exceeding both wait-1 and wait-2 targets; the percentage of patients exceeding wait-1 targets in these models was 0% in all regions, and the percentage exceeding wait-2 targets was 0% except for Ontario West (2.0%, from 35.7% at baseline), East (1.1%, from 22.7% at baseline), and North (1.0%, from 25.1% at baseline).

Interpretation: Coordinated referral and practice models improve access to scheduled surgery in Canadian health systems. Implementation of these models could largely eliminate prolonged wait times for joint replacement surgery in Ontario.