Seyedi Pardis, Aleman Dionne, Baxter Nancy, Bell Chaim, Bodur Merve, Calzavara Andrew, Campbell Robert, Carter Michael, de Jager Pieter, Emerson Scott, Gagliardi Anna, Irish Jonathan, Martin Danielle, Lee Samantha, Saxe-Braithwaite Marcy, Takata Julie, Yang Suting, Zanchetta Claudia, Urbach David
From the Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Ont. (Seyedi, Aleman, Bodur, Carter); Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia (Baxter); the Department of Medicine, Sinai Health System, Toronto, Ont. (Bell); the Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Bell); ICES (Calzavara, Emerson), Research and Analysis (Lee); the Department of Ophthalmology, Queen's University, Kingston, Ont. (Campbell); the Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, N.S. (de Jager); the University Health Network, Toronto General Research Institute, Toronto, Ont. (Gagliardi); the University Health Network, Otolaryngology, Head and Neck Surgery, Toronto, Ont. (Irish); the Department of Family and Community Medicine, University of Toronto, Toronto, Ont. (Martin); the Medfall Group, St. Catharines, Ont. (Saxe-Braithwaite); the Women's College Hospital, Toronto, Ont. (Takata); Data and Decision Sciences, Ontario Health (Yang); Ontario Health (Cancer Care Ontario), Access to Care, Toronto, Ont. (Zanchetta); the Department of Surgery, Women's College Hospital, Toronto, Ont. (Urbach).
From the Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Ont. (Seyedi, Aleman, Bodur, Carter); Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia (Baxter); the Department of Medicine, Sinai Health System, Toronto, Ont. (Bell); the Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Bell); ICES (Calzavara, Emerson), Research and Analysis (Lee); the Department of Ophthalmology, Queen's University, Kingston, Ont. (Campbell); the Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, N.S. (de Jager); the University Health Network, Toronto General Research Institute, Toronto, Ont. (Gagliardi); the University Health Network, Otolaryngology, Head and Neck Surgery, Toronto, Ont. (Irish); the Department of Family and Community Medicine, University of Toronto, Toronto, Ont. (Martin); the Medfall Group, St. Catharines, Ont. (Saxe-Braithwaite); the Women's College Hospital, Toronto, Ont. (Takata); Data and Decision Sciences, Ontario Health (Yang); Ontario Health (Cancer Care Ontario), Access to Care, Toronto, Ont. (Zanchetta); the Department of Surgery, Women's College Hospital, Toronto, Ont. (Urbach)
Can J Surg. 2024 Dec 13;67(6):E397-E405. doi: 10.1503/cjs.002324. Print 2024 Nov-Dec.
Little is known about the existing structure and function of referral networks in the prevalent referral system for specialized surgical care in Canada, which is based on direct physician referral to specialists in a largely unmanaged referral marketplace. Our objective was to describe and analyze the referral networks of referring physicians and surgeons for common surgical procedures in Ontario, to better understand potential barriers to single-entry models.
We analyzed referral networks for patients between referring physicians and surgeons for 9 common scheduled surgical procedures from 2016 to 2019 using administrative data sources in Ontario. We described the connectedness of referring physician-surgeon pairs using descriptive measures and graphical social network analysis.
The median number of surgeons connected to a referring physician for patients having a particular surgical procedure ranged from 1 (interquartile range [IQR] 1-3) for spine surgery to 3 (IQR 1-4) for knee arthroplasty and 3 (IQR 2-5) for noncancer uterine procedures. Referral network structure varied according to the procedure studied. Spine surgery was highly clustered with a small number of larger groups; gallbladder, inguinal hernia, and noncancer uterine surgery were highly distributed with many small groups within the referral network. Breast cancer surgery occurred in a largely distributed network, but with a skewed distribution reflecting a few small groups with large numbers of patients.
Improving surgical wait times by coordinating surgical referrals will require approaches that address the structure of existing referral networks. Most physicians refer their patients to a very small number of surgeons, suggesting that referring physicians largely do not individualize referrals to multiple different surgeons based on specific patient characteristics.
在加拿大普遍存在的专科手术护理转诊系统中，对于转诊网络的现有结构和功能了解甚少。该系统主要基于医生直接向专科医生转诊，处于一个基本无人管理的转诊市场。我们的目标是描述和分析安大略省普通外科手术中转诊医生和外科医生的转诊网络，以更好地理解单入口模式的潜在障碍。
我们利用安大略省的行政数据源，分析了2016年至2019年期间9种常见定期外科手术中转诊医生和外科医生之间患者的转诊网络。我们使用描述性指标和图形化社会网络分析来描述转诊医生与外科医生配对的连通性。
对于接受特定外科手术的患者，与转诊医生有联系的外科医生数量中位数范围从脊柱手术的1名（四分位间距[IQR]为1 - 3）到膝关节置换术的3名（IQR为1 - 4）以及非癌性子宫手术的3名（IQR为2 - 5）。转诊网络结构因所研究的手术而异。脊柱手术高度聚集，有少数较大的群体；胆囊、腹股沟疝和非癌性子宫手术高度分散，转诊网络内有许多小群体。乳腺癌手术发生在一个基本分散的网络中，但分布不均衡，反映出少数有大量患者的小群体。
通过协调手术转诊来改善手术等待时间将需要采取应对现有转诊网络结构的方法。大多数医生将患者转诊给极少数外科医生，这表明转诊医生在很大程度上不会根据患者的具体特征将转诊个性化到多个不同的外科医生。
