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Prioritisation of patients on waiting lists for hip and knee arthroplasties and cataract surgery: Instruments
Alejandro Allepuz1, Mireia Espallargues, Montse Moharra
1Quality in Health Care Area, Catalan Agency for Health Technology Assessment and Research, Carrer de Roc Boronat, 81-95 (segona planta) 08005, Barcelona, Spain. aallepuz@aatrm.catsalut.net
Insights
This study validated prioritization instruments for hip/knee arthroplasty and cataract surgery, finding them reliable for surgical waitlist management. These tools effectively assess patient priority, aiding clinical decision-making.
Area of Science:
- Health Services Research
- Clinical Decision Support
- Surgical Prioritization
Background:
- Prioritization instruments were developed for patients awaiting hip/knee arthroplasty (AI) and cataract surgery (CI).
- Assessing the validity and reliability of these instruments is crucial for effective waitlist management.
Purpose of the Study:
- To evaluate the convergent and discriminant validity of AI and CI.
- To determine the inter-observer reliability of these surgical prioritization tools.
Main Methods:
- A multicenter validation study involving surgeons and ophthalmologists across 10 hospitals.
- Patients' priority was assessed using a visual analogue scale (VAS) and the prioritization instrument, with health-related quality of life (HRQOL) data collected.
- Correlation coefficients and intraclass correlation coefficients (ICC) were calculated to assess validity and reliability.
Main Results:
- Strong correlations were found between the AI and VAS (0.64) and CI and VAS (0.65).
- Moderate correlations were observed between WOMAC and AI (0.39) and VF-14 and CI (0.38).
- High inter-observer reliability was demonstrated for both AI (0.79) and CI (0.79).
Conclusions:
- The prioritization instruments demonstrate acceptable validity and reliability.
- These tools are effective in establishing surgical priority for patients on waitlists.
- Findings support the use of these instruments in clinical practice for improved resource allocation.
Background:
Prioritisation instruments were developed for patients on waiting list for hip and knee arthroplasties (AI) and cataract surgery (CI). The aim of the study was to assess their convergent and discriminant validity and inter-observer reliability.
Methods:
Multicentre validation study which included orthopaedic surgeons and ophthalmologists from 10 hospitals. Participating doctors were asked to include all eligible patients placed in the waiting list for the procedures under study during the medical visit. Doctors assessed patients' priority through a visual analogue scale (VAS) and administered the prioritisation instrument. Information on socio-demographic data and health-related quality of life (HRQOL) (HUI3, EQ-5D, WOMAC and VF-14) was obtained through a telephone interview with patients. The correlation coefficients between the prioritisation instrument score and VAS and HRQOL were calculated. For the reliability study a self-administered questionnaire, which included hypothetic patients' scenarios, was sent via postal mail to the doctors. The priority of these scenarios was assessed through the prioritisation instrument. The intraclass correlation coefficient (ICC) between doctors was calculated.
Results:
Correlations with VAS were strong for the AI (0.64, CI95%: 0.59-0.68) and for the CI (0.65, CI95%: 0.62-0.69), and moderate between the WOMAC and the AI (0.39, CI95%: 0.33-0.45) and the VF-14 and the CI (0.38, IC95%: 0.33-0.43). The results of the discriminant analysis were in general as expected. Inter-observer reliability was 0.79 (CI95%: 0.64-0.94) for the AI, and 0.79 (CI95%: 0.63-0.95) for the CI.
Conclusion:
The results show acceptable validity and reliability of the prioritisation instruments in establishing priority for surgery.