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Referral patterns for common surgical procedures in Ontario: a cross-sectional population-level study
Pardis Seyedi1, Dionne Aleman1, Nancy Baxter1
1From the Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Ont. (Seyedi, Aleman, Bodur, Carter); Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia (Baxter); the Department of Medicine, Sinai Health System, Toronto, Ont. (Bell); the Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Bell); ICES (Calzavara, Emerson), Research and Analysis (Lee); the Department of Ophthalmology, Queen's University, Kingston, Ont. (Campbell); the Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, N.S. (de Jager); the University Health Network, Toronto General Research Institute, Toronto, Ont. (Gagliardi); the University Health Network, Otolaryngology, Head and Neck Surgery, Toronto, Ont. (Irish); the Department of Family and Community Medicine, University of Toronto, Toronto, Ont. (Martin); the Medfall Group, St. Catharines, Ont. (Saxe-Braithwaite); the Women's College Hospital, Toronto, Ont. (Takata); Data and Decision Sciences, Ontario Health (Yang); Ontario Health (Cancer Care Ontario), Access to Care, Toronto, Ont. (Zanchetta); the Department of Surgery, Women's College Hospital, Toronto, Ont. (Urbach).
Most physicians refer patients to a small number of surgeons, indicating a lack of individualized surgical referrals. Understanding these referral networks is key to improving surgical wait times and care coordination.
Area of Science:
- Health Services Research
- Surgical Care Delivery
- Network Analysis
Background:
- Canada's specialized surgical care relies on direct physician referrals within an unmanaged marketplace.
- The structure and function of these referral networks are poorly understood.
- Existing referral patterns may present barriers to implementing coordinated care models.
Purpose of the Study:
- To describe and analyze referral networks between physicians and surgeons for common surgical procedures in Ontario.
- To identify potential barriers to single-entry models for surgical care.
Main Methods:
- Analysis of referral networks for 9 common surgical procedures from 2016-2019 using Ontario administrative data.
- Descriptive measures and social network analysis to assess referring physician-surgeon connectedness.
Main Results:
- Referral network structures varied significantly by surgical procedure.
- Spine surgery networks were highly clustered; gallbladder, hernia, and uterine surgery networks were distributed.
- Breast cancer surgery networks were distributed but skewed, with a few groups managing more patients.
Conclusions:
- Coordinating surgical referrals requires addressing the inherent structure of existing referral networks.
- Physicians typically refer to a limited number of surgeons, suggesting limited individualization of referrals based on patient specifics.
