Table 3.

Differences in the developed APSS-CRDS logic models

Components	Regions
	Region A (mostly centralized)a	Region B (fully centralized)a	Region C (decentralized)a
Outcome areas	Better understanding and clearing already-available wait lists.	Fostering measure-driven outcomes.	Providing proximity health services to patients.
Inputs and strategies
Human resources	A person responsible for each University Health and Social Services Center (French: Centre intégré universitaire de santé et de services sociaux, CIUSSS).		Staff from the local hospitals’ scheduling centers and the offices of doctors working in the community.
	Clinical nursing team.	Clinical nursing team.
	Specialist medical advisor directly involved in managing requests is appointed by the Quebec Ministry of Health and Social Services.	Specialist medical advisor directly involved in managing requests is appointed by the Quebec Ministry of Health and Social Services.	Specialist medical advisors are not appointed by the Quebec Ministry of Health and Social Services but were the regional hospital medical chiefs of staff from different specialists.
Financial resources	Financing a pilot project to support clearing wait lists.	Developing one regional technological tool to access and monitor data.	–
Support	Question and answer document that was shared online.	Presentations about the APSS-CRDS program to specialists and conducted by managers.	Memory aid on the APSS-CRDS functioning for physicians, which included the region’s health trajectories.
		Trainings on using the APSS-CRDS program were offered to physicians and provided by managers.
		Informal support to physicians offered by managers (i.e., physicians could contact them through a direct phone line).
Processes and structures
Registration (i.e, service supply)	Supply is mostly centralized: the CRDS has limited access to specialists’ schedules via the regional digital platform, as this set-up is available solely in hospital settings.	Supply is centralized: the CRDS receives specialists’ availability 7 days in advance to booking and has access to the schedules of specialists registered with the CRDS via digital platforms.	Specialists do not share their availability with the CRDS, it will transfer requests for consultations directly to specialists’ practices for appointment scheduling.
			Exception: the CRDS has access to specialists’ schedules in Region C if they practice in hospital settings.
Pre-requisites	–	Corridors of services allow for the CRDS to schedule patients’ imaging appointments.	–
Clinical review of referrals	Evaluations of referrals conducted by nurses and the specialist medical advisor, who will confirm/decide the clinical priority.	Evaluations of referrals conducted by nurses and the specialist medical advisor, who will confirm/decide the clinical priority.	Evaluations of referrals are conducted by the specialists overseeing the speciality at the hospital or clinic.
Allocation of services	‘Niche,’ specialized practices, limiting the ability to equitably assign patients via the CRDS to registered specialists and complicates the assignation of patients with “general” problems.	Focusing on high priority patients (priority B), hence the CRDS reserves specialists’ time slots specifically for these high priority patients.	Focusing on offering services as close to the patient’s place of residence, hence the development of many different referral trajectories depending on the speciality, priority and the service location.
		Ensuring the equitable distribution of requests to registered specialists given that the CRDS has access to all registered specialists’ time slots.
Communication	Communication with referring physicians Changes in priorities are communicated to the referring physicians.	Communication with referring physicians Changes in priorities are communicated to the referring physicians.	–
	Communication with patients The CRDS calls patients to inform them of their scheduled appointment with the specialist.	Communication with patients The CRDS calls patients to inform them of their scheduled appointment with the specialist.	Communication with patients Clinic and hospital scheduling staff majorly call patients to fix specialists’ appointments. The exception is solely for three specialities, where the CRDS calls patients to inform them of their scheduled appointment with specialists.
	The CRDS will call patients on waiting lists to inquire if consultations are still needed.
	Communication with specialists Specialists communicate with the CRDS for ‘no-show’ patients.	Communication with specialists Specialists communicate with the CRDS for ‘no-show’ patients.	Communication with specialists Information on held appointments is communicated from specialists registered with the CRDS.
	Specialists do not share information with the CRDS on when patient appointments are held.	Specialists do not share information with the CRDS on when patient appointments are held.
Intended impacts
Performance indictors	Eliminating duplication.	Choosing the most useful indicators to ensure reaching outcomes.	Monitoring for completed appointments.
	Better understanding population needs (clinical and cultural) to adapt services and improve understanding of referring physicians’ training needs.		Developing a common language to communicate with physicians about requests meeting target delays.
Monitoring		Developed personalized dashboards with aggregated data on demand and target delay achievement.
	Uses CRDS data to monitor regional specialist staffing plans to inform the Quebec Ministry of Health and Social Services.	Monitors specialists’ CRDS registration.
	CRDS data shared with administrative staff to increase motivation (i.e., areas of improvement, successes)	Shares dashboards with physicians.	Regularly communicates information on service allocation, but this with specialists’ clinics and offices.

^aThe centralized APSS-CRDS was viewed as the creation of a dedicated structure for processing all referral requests across the respective region, and the decentralized model was implemented to build on existing regional structures (i.e., local hospital scheduling centers)