Analysis of Waiting-Time Data in Health Services Research

1. Front Matter

   Pages I-XX

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2. Data, Questions and Methods

   1. Front Matter

      Pages 1-1

      PDF

   2. Health services research on access to care

      • Boris Sobolev, Lisa Kuramoto

      Pages 3-16

   3. Waiting-time data used in this book

      • Boris Sobolev, Lisa Kuramoto

      Pages 17-29

   4. Waits and outcomes: What should be reported?

      • Boris Sobolev, Lisa Kuramoto

      Pages 31-67

3. Waiting-time Studies

   1. Front Matter

      Pages 69-69

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   2. Overview of waiting times and other variables

      • Boris Sobolev, Lisa Kuramoto

      Pages 71-74

   3. Variation and access probabilities

      • Boris Sobolev, Lisa Kuramoto

      Pages 75-86

   4. Factors influencing waiting times

      • Boris Sobolev, Lisa Kuramoto

      Pages 87-110

   5. Surgery after target access time

      • Boris Sobolev, Lisa Kuramoto

      Pages 111-116

   6. Adverse events while waiting

      • Boris Sobolev, Lisa Kuramoto

      Pages 117-140

   7. Intermediate events

      • Boris Sobolev, Lisa Kuramoto

      Pages 141-151

   8. Survival benefit of coronary artery bypass grafting

      • Boris Sobolev, Lisa Kuramoto

      Pages 153-161

4. Back Matter

   Pages 163-207

   PDF

In health care systems that provide universal access to care, efforts to contain costs for standby hospital capacity usually result in wait lists for surgical procedures. When access to health care is rationed by such wait lists, the length of time that patients are required to wait is usually uncertain. This uncertainty is a natural product of stochastic variation in service time and in the percentage of urgent cases in any queuing system. However, in a queue for elective (nonemergency) procedures, waiting-time uncertainty has many additionalcauses. Forinstance,decisionsofbothpatientsandcareprovidersmayoverrideaqueuediscipline. Alternatively, the lack of a hospital resource, such as beds in the intensive care unit, may change queuing practices in favor of services that would not require the resource. Waiting time is often compared between regions, hospitals, periods, or surgical services to evaluate p- icy and performance. However, surprisingly little attention has been given to the variation in times spent in a single queue. Why some patients wait longer than others remains an important question in health services - search. Itisunclear,forexample, whether timetoservicevariesmorethanwouldbeexpected throughchance alone after differences in clinical condition are taken into account. Another important issue is preferential allocation of hospital resources. It also remains unclear whether patients of low priority are admitted directly as a way to circumvent long wait lists or to substitute for cancellations on the operating room schedule.

• MATLAB
• Radiologieinformationssystem
• SAS
• data analysis
• health care delivery
• patient flow
• patients

From the reviews:

"Sobolev and Kuramoto … offer fellow researchers a guide to methodology for studying how long patients in a universal health-care system wait for elective or other non-emergency surgery. In addition to providing statistical tools, they set out the entire research process, from framing the question to interpreting results." (SciTech Book News, June, 2008)

• Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada

  Boris Sobolev

• Vancouver Coastal Health Research Institute, Centre for Clinical Epidemiology&Evaluation, Vancouver, Canada

  Lisa Kuramoto

Boris Sobolev is Associate Professor in the Department of Health Care and Epidemiology at the University of British Columbia.

Lisa Kuramoto is a Statistical Analyst with the Vancouver Coastal Health Services Research Institute.

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