Patient-reported outcomes and surgical triage: A gap in patient-centered care?

Abstract

To help address wait times for elective surgery, British Columbia has implemented a triaging system that assigns priority levels to patients based on their diagnoses. The extent to which these priority levels concords with patients' assessment of their health status is not known. The purpose of this study was to measure the association between the priority levels assigned to patients and their patient-reported outcomes data collected at the time of being enrolled on the surgical wait list. Patients waiting for elective surgery in the Vancouver Coastal Health Authority were sampled. Participants completed a set of generic and condition-specific patient-reported outcome instruments, including: the EQ-5D(3L) (general health), PEG (pain), and the PHQ-9 (depression). A multivariate ordered logistic model was used to regress patient-reported outcome values on the priority level assigned at the time of wait list registration. A total of 2725 participants completed the survey package (response rate 49%). Using the EQ-5D(3L), 63% reported having problems with pain or discomfort, 41% problems performing usual activities, 36% problems with depression or anxiety, 28% problems with mobility, and 8% a problem with self-care. The results from the ordered logistic model indicated very little association between the patient-reported outcomes and wait list priority levels, when adjusted for patient factors. This study observed no relationship between patients' self-reported health status and their assigned priority level for elective surgery. A more patient-centered approach to triaging patients for surgical treatment would incorporate patients' perspective in surgical wait list prioritization systems.