Table 1.
Key performance indicators for musculoskeletal centralized intake
| Key performance indicator | Dimension of quality of care | Derived from existing measure | Included or removed after round 2 |
|---|---|---|---|
| 1. Time from osteoarthritis referral receipt to referral completion for initially incomplete referrals | Accessibility, efficiency | New KPI | Included |
| 2. Time from rheumatoid arthritis referral receipt to referral completion for initially incomplete referrals | Accessibility, efficiency | New KPI | Included |
| 3. Percentage of osteoarthritis referrals received with complete information | Efficiency | Hip and Knee Replacement Measurement Frameworka,b | Included |
| 4. Percentage of rheumatoid arthritis referrals received with complete information | Efficiency | New KPI | Included |
| 5. Time from receipt of complete osteoarthritis referral to musculoskeletal appointment | Accessibility | Hip and Knee Replacement Measurement Frameworka,b | Included |
| 6. Waiting times for rheumatologist consultation for patients with new-onset rheumatoid arthritis | Accessibility | AAC Performance measures for IAc | Included |
| 7. Time to disease-modifying antirheumatic drug therapy for patients with new-onset rheumatoid arthritis | Accessibility, effectiveness | AAC Performance measures for IAc | Included |
| 8. Percentage of patients with new-onset rheumatoid arthritis with at least one visit to a rheumatologist in the first year of diagnosis | Accessibility | AAC Performance measures for IAc | Included |
| 9. Orthopaedic surgeons per 100,000 population | Accessibility | COAd,e, AAOSf, ACREUe,g | Removed |
| 10. Rheumatologists per 100,000 population | Accessibility | AAC Performance measures for IAc | Included |
| 11. Percentage of patients that receive information regarding resources and tools available for management while waiting for first musculoskeletal specialty contact | Appropriateness | Hip and Knee Replacement Measurement Frameworka,b | Included |
| 12. Percentage of osteoarthritis referrals scored using Western Canada Waiting List priority referral criteriah | Appropriateness | New KPI | Included |
| 13. Distribution of osteoarthritis referrals in each urgency category (as scored using the Western Canada Waiting List referral tool) | Appropriateness | New KPI | Included |
| 14. Percentage of osteoarthritis referrals triaged as highest urgency based on high Western Canada Waiting List priority criteria scores seen within Wait Time Alliance benchmarks | Appropriateness | New KPI | Included |
| 15. Percentage of rheumatoid arthritis referrals assessed using a priority tool | Appropriateness | New KPI | Removed |
| 16. Percentage of rheumatoid arthritis referrals categorized as early rheumatoid arthritis | Appropriateness | New KPI | Removed |
| 17. Waiting times for patients with established rheumatoid arthritis | Accessibility | New KPI | Included |
| 18. Percentage of rheumatoid arthritis patients treated with a disease-modifying antirheumatic drug during the measurement year | Effectiveness, accessibility | AAC Performance measures for IAc | Included |
| 19. Percentage of referrals rejected or redirected when received at centralized intake | Appropriateness | New KPI | Included |
| 20. Percentage of musculoskeletal appointments completed as scheduled | Efficiency | Hip and Knee Replacement Measurement Frameworka,b | Included |
| 21. Percentage of specialist providers participating in centralized intake | Efficiency | New KPI | Included |
| 22. Number of referrals received through centralized intake | Efficiency | New KPI | Included |
| 23. Patient experience with centralized intake | Acceptability | AHRQi, NHSj, and Ministry of Health and Long-Term Care (Ontario)k | Included |
| 24. Referring clinician experience with centralized intake | Acceptability | The Ministry of Health and Long-Term Care (Ontario)k | Included |
| 25. Musculoskeletal specialty care provider experience with centralized intake | Acceptability | The Ministry of Health and Long-Term Care (Ontario)k | Included |
| 26. Ratio of patient flow to estimated clinic capacity of osteoarthritis teams participating in centralized intake | Efficiency, accessibility | Developed during round 2 | N/A |
| 27. Operating room time for arthroplasty surgeons in Alberta | Accessibility | Developed during round 2 | N/A |
| 28. Ratio of patient flow to clinic capacity of rheumatoid arthritis teams participating in centralized intake | Efficiency, accessibility | Developed during round 2 | N/A |
| 29. Administrative staff and allied health professional experience with centralized intake | Acceptability | Developed during round 2 | N/A |
| 30. Agreement of centralized intake suspected diagnosis of severe osteoarthritis cases (e.g., patients who are candidates for hip or knee joint replacements) versus confirmed diagnosis of severe osteoarthritis | Appropriateness, effectiveness | Developed during round 2 | N/A |
| 31. Agreement of centralized intake suspected diagnosis versus confirmed diagnosis for rheumatoid arthritis | Appropriateness, effectiveness | Developed during round 2 | N/A |
| Total number of candidate KPIs before round 2: 25 | Total number of candidate KPIs after round 2: 28 |
AAC Arthritis Alliance of Canada, IA Inflammatory Arthritis, AAOS American Academy of Orthopaedic Surgeons, ACREU Arthritis Community Research and Evaluation Unit, AHRQ Agency for Healthcare Research and Quality, COA, Canadian Orthopaedic Association, NHS, National Health Service
aFrank et al. [27]
bMarshall et al. [39]
cBarber et al. [26]
dRumble and Kreder [40]
eBadley et al. [17]
fNatividad [41]
gCanizares et al. [42]
hThe Western Canada Waiting List (WCWL) Project has developed and validated a hip and knee replacement priority criteria tool to assess clinical urgency for hip and knee joint replacements in a standardized and reliable manner [43]. The hip and knee replacement priority criteria tool is a clinician-scored tool consisting of seven items: (1) pain on motion, (2) pain at rest, (3) ability to walk, (4) other functional limitations, (5) abnormal findings, (6) potential for progression of disease and (7) ability to work, give care to dependents and live independently. The urgency is determined through a point count scoring system and could be used to structure and manage waiting lists for hip and knee joint replacements [44]
iCamacho et al. [45]
jClinical Indicators Team [46]
kDeloitte & Touche LLP and affiliated entities [47]