ArticleBMJ open2019
Improving the quality of care with a single-entry model of referral for total joint replacement: a preimplementation/postimplementation evaluation.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review.BMC health services research · 2021Pooled it
- Patient prioritisation methods to shorten waiting times for elective surgery: A systematic review of how to improve access to surgery.PloS one · 2021Pooled it
- Effect of single-entry referral models and team-based care on wait times for hip and knee joint replacement in Ontario: a simulation study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2025Article
- Exploratory analysis using discrete event simulation modelling of the wait times and service costs associated with the maximum wait time guarantee policy applied in a rheumatology central intake clinic.Health systems (Basingstoke, England) · 2025Article
- Improving access to chronic pain care with central referral and triage: The 6-year findings from a single-entry model.Canadian journal of pain = Revue canadienne de la douleur · 2024Article
- Prioritization of patients for surgery in Canada: The case of hip and knee replacement surgeries in Newfoundland.Public health challenges · 2023Article
- Centralized Intake Models and Recommendations for Their Use in Non-Acute Mental Health Services: A Scoping Review.International journal of environmental research and public health · 2023Article
- A Simulation Modelling Study of Referral Distribution Policies in a Centralized Intake System for Surgical Consultation.Journal of medical systems · 2022Article
- A single-entry model and wait time for hip and knee replacement in eastern health region of Newfoundland and Labrador 2011-2019.BMC health services research · 2022Article
- Exploring the implementation and underlying mechanisms of centralized referral systems to access specialized health services in Quebec.BMC health services research · 2021Article
- Article
- Confronting the COVID-19 surgery crisis: time for transformational change.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2020Article
- Wait times for degenerative lumbar spine consultation and surgery: a repeated cross-sectional analysis of the Canadian Spine Outcomes and Research Network.Canadian journal of surgery. Journal canadien de chirurgieObservational
- "My Quality of Life is Not There. I'm Dying Here. I Cannot Take This Anymore." Exploring Patient Experiences With Surgical Wait Times in Otolaryngology: A Mixed Methods Study.Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-facialeArticle
- Selective centralized booking as a low-cost alternative to centralized referral.Canadian journal of surgery. Journal canadien de chirurgieArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
objectivesWe assessed: (1) waiting time variation among surgeons; (2) proportion of patients receiving surgery within benchmark and (3) influence of the Winnipeg Central Intake Service (WCIS) across five dimensions of quality: accessibility, acceptability, appropriateness, effectiveness, safety.
designPreimplementation/postimplementation cross-sectional design comparing historical (n=2282) and prospective (n=2397) cohorts.
settingRegional, provincial health authority.
participantsPatients awaiting total joint replacement of the hip or knee.
interventionsThe WCIS is a single-entry model (SEM) to improve access to total hip replacement (THR) or total knee replacement (TKR) surgery, implemented to minimise variation in total waiting time (TW) across orthopaedic surgeons and increase the proportion of surgeries within 26 weeks (benchmark). Impact of SEMs on quality of care is poorly understood. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes related to 'accessibility': waiting time variation across surgeons, waiting times (Waiting Time 2 (WT2)=decision to treat until surgery and TW=total waiting time) and surgeries within benchmark. Analysis included descriptive statistics, group comparisons and clustered regression.
resultsVariability in TW among surgeons was reduced by 3.7 (hip) and 4.3 (knee) weeks. Mean waiting was reduced for TKR (WT2/TW); TKR within benchmark increased by 5.9%. Accessibility and safety were the only quality dimensions that changed (post-WCIS THR and TKR). Shorter WT2 was associated with post-WCIS (knee), worse Oxford score (hip and knee) and having medical comorbidities (hip). Meeting benchmark was associated with post-WCIS (knee), lower Body Mass Index (BMI) (hip) and worse Oxford score (hip and knee).
conclusionsThe WCIS reduced variability across surgeon waiting times, with modest reductions in overall waits for surgery. There was improvement in some, but not all, dimensions of quality.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.