NWT RESEARCH DATABASE

Regions: North Slave Region

Tags: health, health care

Objective(s): To answer the research question “What are the costs of delayed medical referrals in Canada’s Northwest Territories?”

Project Description: This research is a study looking at wait time 1, the length of time between the date a patient is referred to a specialist and the date they actually see the specialist, for primary care across Canada. In the Northwest Territories, the research team will quantify wait time 1 and also answer the research question “What are the costs of delayed medical referrals in Canada’s Northwest Territories?” The research team will conduct a retrospective chart audit of a primary care practice in Yellowknife. The team will extract information from at least 100 charts for which referral letters were sent during a time-period of roughly one month or longer (if less than 100 patients were referred during the month). All referral letters will be selected from the clinic for a time-period that will allow the team to sample at least 100 charts. Data will be abstracted from the corresponding charts through a retrospective chart audit of electronic medical records (EMR) performed by a medical student or resident currently working in the Northwest Territories (NT) in collaboration with a student from the Champlain BASE™ team who will input the de-identified data onto the secure database form. Only the medical student or resident will have access to the EMR and patient information. De-identified data will be stored on a secure server at the Winchester District Memorial Hospital. Chart abstractors will not store any information in any other place (i.e. laptop, USB key, paper copy, etc.). The site is password protected and conforms to the existing patient privacy legislation in Ontario, which should be equivalent to the requirements in other Canadian provinces and territories. The only people who will have access to the de-identified information will be members of the research team directly involved in the data collection or analysis. Electronic files will be kept for a period of ten years after the completion of the study. The data is de-identified upon extraction, as the only patient identifiers to be collected are the first three digits of the patient’s postal code, which is being collected to allow us to conduct the patient cost and socioeconomic analyses as outlined below. Therefore, there is no risk to patient anonymity. The data will be downloaded and stored on the secure servers at the Bruyère Research Institute in Ottawa for analysis. Descriptive statistics will be used to characterize referral, practice, and patient data. Planned Analysis One dependent variable is specialist wait time and this will be calculated in days between date the referral is made to the date the patient is seen by the specialist. Wait times do not typically follow a normal distribution, therefore medians and 75th percentiles will be calculated. The research team will examine differences in wait times across specialty types, clinics, patient gender, patient age, rurality, and socio-economic status (SES). SES will be calculated based on the first three digits of the patient’s postal code and linking to census data from Statistics Canada. Another dependent variable will be health system and patient utilization costs during wait time 1. These will be quantified based on the appropriate fee schedules and available datasets. Medians and 75th percentiles of costs will be calculated. The research team will examine differences in health system utilization costs and patient costs across specialty types, clinics, patient gender, patient age, rurality, SES, and wait time. This project is examining the costs of delayed medical referrals for the people of the Northwest Territories (NT). The information gained can help decision makers and healthcare providers understand the impact and costs of delayed medical referrals, which will help create innovative solutions to reduce the health and economic burden on citizens. The research team will prepare a briefing note for the Deputy Minister of Health, present results at scientific conferences and publish in peer-reviewed scientific journals. The team will work together to prepare reports for the healthcare providers (primary care providers and specialists) to share with their clients as they deem appropriate. The abstracts will be posted on a public website (www.champlainBASEeConsult.ca). The fieldwork for this study will be conducted from October 17, 2016 to December 31, 2016.