Dossier n. 147/2007 [Abstract] Elaboration and validation of a tool for clinical prioritarisation in orthopaedic surgery

Fair access to elective service is a primary concern of every publicly funded health care system. In principle, patients with more urgent conditions should receive services ahead of those with less urgent condition. Standardized measures are needed to assess reliably patients priority taking into account their relevant clinical characteristics.

This paper reports a study assessing validity and reliability of a tool for clinical prioritarisation of patient referred for elective orthopaedic surgery.

In particular, a point-count scoring tool was developed by a regional expert panel including six orthopaedic surgeons.

 The tool was then applied by 14 orthopaedic surgeons on a sample of 7 hypothetical cases. Concurrently, members of the panel were also asked to judge the clinical priority of each case on a 0-10 scale, and express an explicit judgement as for the maximum waiting time deemed acceptable for each.

 As desired by concurrent validity criteria, there was a strong correlation between the priority score and the priority judgement on the 0-10 scale (r = 0,870/0,906 p<0,01), as well as between the priority score and the maximum acceptable waiting time (r=- 0,737/-0,811 p<0,01).

The tool had also excellent inter-rater (ICC: 0,87 and 0,82) and test-retest reliability (ICC: 0,75).

The panelists agreed that the tool was sufficiently accurate in representing how orthopaedic surgeons actually view the relative priority of their patient.

After this development phase, the tool now needs to be empirically assessed as for its actual applicability within the clinical environments.