Biomedical subjects

David C Hadorn

Publications and source records attributed to David C Hadorn.

7 recordsLinked to original sources

PubMed2003

Developing priority criteria for hip and knee replacement: results from the Western Canada Waiting List Project.

INTRODUCTION: The Western Canada Waiting List Project (WCWL), a federally funded partnership of 19 organizations, was created to develop tools for managing waiting lists. The WCWL panel on hip and knee replacement surgery was 1 of 5 panels constituted under this project. METHODS: The panel developed and tested a collection of standardized clinical criteria for setting priorities among patients awaiting hip and knee replacement. The criteria were applied to 405 patients in 4 provinces. Regression analysis was used to determine the set of criteria weights that collectively best predicted clinicians' overall urgency ratings. Inter-rater and test-retest reliability was assessed from 6 videotaped patient interviews, scored by orthopedic surgeons, related professionals and general practitioners. RESULTS: The priority criteria accounted for over two-thirds of the observed variance in overall urgency ratings (adjusted R2 = 0.676). The panel modified the criteria and weights based on the empirical findings and on clinical judgement. The reliability of the priority criteria for the hip and knee replacement tool was among the strongest of the 5 instruments developed in the WCWL project. CONCLUSIONS: The panel considered the criteria easy to use and reasonably reflective of expert surgical judgement regarding clinical urgency for hip and knee replacement. Further development and testing of the tool appears warranted.

Arthroplasty, Replacement, Hip↗

PubMed2002

Developing cataract surgery priority criteria: results from the Western Canada Waiting List Project.

BACKGROUND: The Western Canada Waiting List Project (WCWL) is a federally funded partnership of 19 organizations, including medical associations, health authorities, ministries of health and research organizations, that was created to develop tools to assist in the management of waiting lists. The WCWL cataract surgery panel, one of five panels constituted under this project, developed and tested a set of standardized clinical criteria for prioritizing among patients awaiting cataract surgery. METHODS: The cataract surgery panel was composed of seven academic and community ophthalmologists, two family physicians, an optometrist, a health care services researcher and a health information specialist. The panel met three times between October 1999 and June 2000. The priority criteria were applied to 563 patients in the four western provinces. Regression analysis was used to determine the set of criteria weights that collectively best predicted clinicians' overall ratings of urgency. Interrater and test-retest reliability were assessed, based on clinicians' ratings of videotaped interviews with six hypothetical patients. RESULTS: The resulting criteria accounted for about one-third of the observed variance in clinicians' ratings of overall clinical urgency (R2 = 31.2%). The panel modified the original criteria and weights based on empirical results and clinical judgement. Reliability of the revised criteria items was mixed, with the lowest reliability observed for items dealing with glare and social role. INTERPRETATION: Participating clinicians considered the criteria easy to use and reasonably reflective of expert surgical judgement regarding clinical urgency. Further development and testing of the tool appear warranted.

British Columbia↗

PubMed2002

Lining up for children's mental health services: a tool for prioritizing waiting lists.

OBJECTIVE: The Western Canada Waiting List Project (WCWL) is a federally funded partnership of 19 health-related organizations that was created to develop tools to manage waiting lists for five types of health services. METHOD: The children's mental health (CMH) panel developed and tested a set of standardized clinical criteria for setting priorities among patients awaiting CMH services. The criteria were applied to 817 patients by 92 mental health professionals in three western provinces. Regression analysis was used to determine the set of criteria weights that collectively best predicted clinicians' global urgency ratings. To assess reliability, raters used the criteria to score six standardized "paper cases." RESULTS: The criteria accounted for about 40% of the observed variance in overall urgency ratings (R2 = 41.7%). The panel modified the criteria on the basis of the initial empirical work. Reliability assessment of the revised tool indicated that half of the items had excellent or fair/good interrater agreement; test-retest reliability was good. CONCLUSIONS: Priority criteria were able to capture clinicians' judgments of relative urgency in the CMH setting. A number of operational challenges remain with the use of priority criteria for scheduling CMH services. Further development and testing of the tool appear warranted.

Adolescent↗

PubMed2002

Developing priority criteria for general surgery: results from the Western Canada Waiting List Project.

OBJECTIVE: The Western Canada Waiting List Project (WCWL) is a federally funded partnership of 19 organizations, including medical associations, health authorities, ministries of health and research organizations that was created to develop tools for improving the management of waiting lists. The WCWL general surgery panel was 1 of 5 panels constituted under this project. METHOD: The panel developed and tested a set of standardized clinical criteria for setting priorities among patients awaiting elective general surgery of all kinds. The criteria were applied to 561 patients in 3 western provinces. Regression analysis was used to determine the set of criteria weights that collectively best predicted clinicians' overall urgency ratings. RESULTS: The priority criteria accounted for almost two-thirds of the observed variance in clinicians' urgency ratings (adjusted R2 = 64.1%) for a mixed group of patients. The panel modified the criteria and weights based on empiric findings and clinical judgment. Interrater and test-retest reliability of criteria items appeared to be good, based on clinicians' ratings of 6 videotaped, standardized patient interviews. CONCLUSIONS: The panel considered the criteria easy to use and reasonably reflective of expert surgical judgement regarding clinical urgency. Further development and testing of the tool appears warranted.

Canada↗

PubMed2002

Developing priority criteria for magnetic resonance imaging: results from the Western Canada Waiting List Project.

OBJECTIVE: The Western Canada Waiting List (WCWL) Project is a federally funded partnership of 19 organizations, including medical associations, health authorities, ministries of health and research organizations, that was created to develop tools to assist in assessing the relative urgency and priority of patients on waiting lists. The WCWL panel on magnetic resonance imaging (MRI) was 1 of 5 panels constituted under this project. METHODS: The panel developed and tested a set of standardized clinical criteria for setting priorities among patients awaiting MRI. The criteria were applied to 407 patients in the 4 western provinces. Regression analysis was used to determine the set of criteria weights that collectively best predicted clinicians' overall ratings of patients' urgency for MRI. Reliability was assessed using clinicians' ratings of 6 hypothetical paper cases. RESULTS: The resulting weighted criteria accounted for about two-fifths of the observed variance in overall urgency ratings (R2 = 39.9%). The panel then modified the criteria on the basis of regression results and clinical judgment. Most of the revised criteria items showed poor inter-rater reliability, but test-retest reliability (over a 2-month interval) was relatively good. CONCLUSION: Criteria items requiring probability judgments were a challenge for clinicians. Further development and testing of the tool appears warranted, although considerable question remains concerning the utility of priority criteria for MRI and other diagnostic services.

Canada↗

PubMedDate not supplied

The Oregon priority-setting exercise: quality of life and public policy.

In 1989 the Oregon State legislature passed the Oregon Basic Health Services Act, which created a Health Services Commission charged with "developing a priority list of health services, ranging from the most important to the least important for the entire population to be served." The goal of this legislation was to permit the expansion of Medicaid to 100 percent of all Oregonians living in poverty by covering only services deemed to be of sufficient importance or priority...Instead, the OHSC developed a set of seventeen health service "categories," which described either a specific type of service...or, more generically, the expected outcomes of care... Commissioners formally ranked these seventeen categories in order of importance according to three subjective criteria: value to the individual, value to society, and whether the category seemed "necessary." Each treatment was then assigned to the single most appropriate category, based on Commissioners' judgment. Services were ranked within categories according to the degree of benefit expected from treatment... Estimates of how treatments affect quality of life were by far the single most important factor in determining the priority order on that list....

Biomedical Technology↗

PubMedDate not supplied

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Conflict of Interest↗