Canadian Institute for Health Information

1. Canadian Institute for Health Information

2. Wait Time Information in Priority Areas: Definitions Updated May 2012

3. Background • In 2004, Canada's first ministers agreed to work towards reducing wait times for five priority areas: cancer treatment, cardiac care, diagnostic imaging, joint replacement and sight restoration. CIHI was mandated to collect wait times information and monitor provincial progress in meeting benchmarks. • Since 2004, CIHI and the provinces have collaboratively worked towards the development of indicators and public wait times reporting for five priority procedures and two diagnostic imaging procedures.

4. Background • In 2005, the Comparable Indicators of Access Sub Committee (CIASC) developed a pan-Canadian definition for wait time measurement which was adopted by the federal/provincial/territorial ministries. • The definition of start date for wait time measurement was defined as follows: “Waiting for a health service begins with the booking of a service, which is when the patient and the appropriate physician agree to a service, and the patient is ready to receive it.” • The definition of finish date for wait time measurement was defined as follows: “Waiting for a service ends when the patient receives the service, or the initial service in a series of treatments or services.”

5. Procedures for Which Wait Times Information Is Currently Being Reported • Hip replacement • Knee replacement • Hip fracture repair • Cataract • Coronary artery bypass graft (CABG) • Radiation therapy • MRI • CT

6. Reporting for Hip Replacement As of 2010, the following definition and population have been applied to CIHI’s reporting for hip replacement surgery wait times: Definition The number of days a patient waited, between the booking date and the date the patient received a planned total hip replacement. Benchmark Within 26 weeks (182 days) Time Frame April 1 to September 30, annually Population • Includes those age 18 and older • Includes all total hip replacements (primary and revision); bilaterals count as a single wait • For all priority levels • Excludes emergency cases • Excludes elective partial hip replacements and hip-resurfacing techniques • Excludes days when the patient was unavailable Decisions/Rationale • The inclusion of bilateral hip replacements, patients younger than age 18, and/or out-of-province patients are not material to the reported wait times for hip replacements. These are not reported as exceptions for provinces that are unable to remove these cases from their data. • Provinces continue to work towards removing “patient unavailable” days from reported wait times. This will continue to be an area of variation which CIHI will note.

7. Reporting for Knee Replacement As of 2010, the following definition and population have been applied to reporting for knee replacement surgery wait times: Definition The number of days a patient waited, between the booking date and the date the patient received a planned total knee replacement. Benchmark Within 26 weeks (182 days) Time Frame April 1 to September 30, annually Population • Includes those age 18 and older • Includes all total knee joint replacements (primary and revision); bilateral joints count as a single wait • For all priority levels • Excludes emergency cases • Excludes knee-resurfacing techniques • Excludes days when the patient was unavailable Decisions/Rationale • The inclusion of bilateral knee replacements, patients younger than age 18 and out-of-province patients are not material to the reported wait times for knee replacements. These will not be reported as exceptions for provinces that are unable to remove these cases from their data. • Provinces continue to work towards removing “patient unavailable” days from reported wait times. This will continue to be an area of variation which CIHI will note.

8. Reporting for Hip Fracture Repair As of 2010, the following definition and population have been applied to reporting for hip fracture repair wait times: Definition 1. Measured from the time of first registration at an emergency department with hip fracture (index admission) to the time when hip surgery was received. AND/OR 2. Measured from the time of first inpatient admission with hip fracture (index admission) to the time when hip surgery was received. Benchmark Within 48 hours Time Frame April 1 to September 30, annually Population • Ages 18 and older • Discharge from an acute care institution • Admission category recorded as emergent/urgent (if wait from first inpatient admission) • Excludes in-hospital hip fractures Decisions/Rationale • In-hospital hip fractures are excluded as the time of the fracture or start of wait is not known.

9. Reporting for Cataract Surgery • As of 2010, the following definition and population have been applied to reporting for cataract surgery wait times: • Definition • The number of days that patients waited, between the booking date and the date the patient received cataract surgery. Benchmark Within 16 weeks (112 days) Time Frame April 1 to September 30, annually • Population • Ages 18 and older • For first eye only; bilateral cataract removal counts as a single wait • For all priority levels • Excludes emergency cases • Excludes days when the patient was unavailable • Reviewed April 19, 2011 • Decisions/Rationale • CIHI will note the cases that have been included in which a procedure has been performed on the second eye. • There is no universal definition for high-risk cataract surgery procedures across provinces, hence, they are not consistent across jurisdictions. CIHI will note where high-risk patients are included. • Inclusion of out-of-province patients is not material to the reported wait times for cataract surgery. These are not reported as exceptions for provinces that are unable to remove these cases from their data. • Provinces continue to work towards removing “patient unavailable” days from reported wait times. This will continue to be an area of variation which CIHI notes. • Rationale for Inclusion of First Eye Only: Provincial start times for the wait for cataract surgery for the second eye vary (booking date, DTT, time of first surgery). About 40% of all cataract surgery procedures involve the second eye. Taken together, including this wait will likely materially affect reported waits.

10. Reporting for Coronary Artery Bypass Graft Surgery (CABG) As of 2011, the following definition and population have been applied to reporting for bypass surgery wait times: Definition The number of days that patients waited, between the booking date and the date the patient received a coronary artery bypass graft (CABG). Benchmark Within 2 to 26 weeks (14 to 182 days), depending on how urgently care is needed. Time Frame April 1 to September 30, annually Population • Includes those age 18 and older • Includes Isolated CABG only • For all priority levels • Excludes emergency cases • Excludes days when the patient was unavailable Decisions/Rationale • The inclusion of out-of-province patients and those younger than age 18 is not material to the reported wait times for bypass surgery. Inclusion of these patients will not be reported as an exception. • Provinces continue to work towards removing “patient unavailable” days from reported wait times. This will continue to be an area of variation which CIHI notes.

11. Reporting for Radiation Therapy As of 2011, the following definition and population will apply to reporting for radiation therapy wait times: Definition The number of days that patients waited, between the date the patient is “ready to treat” and the date of the first radiation therapy treatment. Benchmark Within 4 weeks (28 days) of patient being ready to treat Time Frame April 1 to September 30, annually Population • Includes adults (those age 18 and older) • All referrals to start or initiate radiation treatment • All priority levels and all cancer types rolled up • Excludes days when the patient was unavailable • Includes oncology planning time Reviewed April 19, 2011 Provinces that include radiation treatments other than external beam are noted in the exceptions. Decisions/Rationale • Pediatrics and emergency patients are included as their inclusion is not material to the reported wait times for radiation therapy. The inclusion of these patients will not be reported as an exception for those provinces that do report in this manner. • All referrals to start or initiate treatment may include patients who have had previous radiation treatment for the same or other cancers, patients who have metastases from a previous cancer and/or palliative patients. • Provinces that include radiation treatments other than external beam will be noted in the exceptions.

12. Reporting for CT and MRI Scans As of 2010, the following definition and population have been applied to reporting for CT and MRI wait times: Definition The number of days that patients waited, between the date the order/requisition is received and the date of the date the patient received the scan. Time Frame April 1 to September 30, annually Population • Includes adults (those age 18 and older) • Includes diagnostic scans (may be inpatient and/or outpatient) • For all priority levels • Excludes routine follow-up scans • Excludes mammography screening and prenatal screening Decisions/Rationale • The inclusion of emergency patients is not material to the reported wait times for diagnostic imaging. These will not be reported as an exception. • Routine follow-up scans are material to reported wait times as they comprise between10% and 15% of all cases and typically might occur at a six-month or annual cycle and would contribute to long “waits” if left in. Several provinces are able to identify routine follow-up scans via a flag in their databases. For those unable to identify follow-ups, CIHI will note this as an exception. • Mammography screening and prenatal screening will not be included in the population and will be noted in the population.