SAGE 2015 was a short survey conducted during the week of April 20th – 24th to provide a snapshot of how long Canadians wait for digestive and liver disease consultation and procedures. Specialists recorded 5-6 data points on at least five new, consecutive consults and five new, consecutive procedure patients (outpatients only).
Who Could Participate?
Gastroenterologists and internists specializing in adult gastroenterology were requested to participate, provided they record the date that patients are first referred.
Survey findings identified the median wait times for gastroenterology services continue to exceed recommended targets and have significantly worsened since 2005.
In 2005 many clinician Canadian Association of Gastroenterology (CAG) members participated in PAGE Wait Times Program to provide ground breaking national data on wait times for digestive health care, which ultimately secured the CAG's position within the federal Wait Time Alliance.
In 2008 the CAG designed the Survey of Access to GastroEnterology (SAGE) program to provide a snapshot of wait times related to the 18 non-urgent indications referenced in the Canadian consensus on medically acceptable wait times for digestive health care. Survey findings identified the median wait times for gastroenterology services continue to exceed recommended targets and have significantly worsened since 2005. Project findings were published in the 2011 Wait Time Alliance report card.
The CAG continues to explore the issues behind excessive wait times in order to ultimately improve access. The SAGE 2015 survey is the same short survey as was done in 2012 (with a few minor changes) and will provide us with a current snapshot of wait times allowing us to compare results and identify trends.
The survey includes nine one-time, physician demographic questions, as well as five questions per consult and six questions per procedure patient (less than 1 minute per patient entry).
To view a sample of the SAGE 2015 survey, click here.
NOTE: The program is now CLOSED.
The CAG has obtained ethics approval from a national ethics review group and some provinces, which have a central ethics review, have also signed off. You will know your local circumstances best, but this is not a study so much as a practice audit; no patient identifiers are being collected.
When we initiated PAGE it was novel, even unique. We need to keep refreshing the survey and adding features that will draw media attention to the issue of wait times and access to gastroenterology services. There is currently sensitivity across the health care system surrounding rural versus urban access. Access equity is an important issue for government and Canadians.
This year we would like to capture SAGE data regarding the patients’ location; rural or urban. Everyone’s postal code identifies if they live in an urban or rural area. A ‘0’ as the second character indicates a rural location; for example, B0H 4M3 is a rural postal code, while B3H 4M3 is an urban postal code. We can easily capture this data by simply answering a tick box question for each survey patient, Yes or No, to the SAGE question, “Is the second character of the patient’s home postal code a ‘0’?”
The CAG feels that SAGE is a quality assurance/practice audit project which should not warrant ethics review because:
- SAGE collects the minimum amount of information needed to monitor wait times; only 4‐5 data points are recorded per patient.
- SAGE does not collect patient identifiers: none of the identifiers of patient name, patient initials, sex, date of birth or numeric identifier is recorded.
- The very general information captured, and lack of typical identifiers as noted above, does not allow for identification of a particular patient. Thus, the patient and their information remain anonymous.
- Individual data entries in SAGE are not useful and will not be reported; rather it is only the aggregate results from all patients that will be reported to provide a view to trends in wait times.
- SAGE is a survey; it does not involve any patient intervention or change in how patients are managed and thus carries no risk to the patient.
SAGE is intended to be completed at sites where the local ethics committee review is not required – the CAG is not asking physicians to submit to and obtain ethics committee approval.
SAGE will provide data on:
- The waiting time to consultation (time between when the patient is first referred and the specialist consultation)
- The waiting time to procedure (time between the specialist consultation and when the procedure is performed)
- Total waiting time (time between when the patient is first referred and the procedure is performed) for the 19 pre-identified indications, and will
- Compare wait times with the 19 consensus conference recommendations of appropriate waiting times and SAGE 2015 data, as well as with previous wait time data
Statistical analyses will be performed on aggregate findings (nationally and possibly regionally) from SAGE, which will form the basis of communications on current wait times for gastroenterology consultation and procedures; individual results will not be reported. Aggregate provincial/regional findings (no individual results) can also be made available to the respective provincial/regional gastroenterology society to support local advocacy and health care access improvements. Findings may be examined relative to the data collected in 2005, 2008, 2012 and 2015 to determine if waits have lengthened, improved or remain unchanged.
The core SAGE Advisory Group includes
Des Leddin (Chair), Dalhousie University, Halifax, NS
Carlo Fallone, McGill University, Montreal, QC
Mark Borgaonkar, Memorial University, St. John’s, NL
Kerri Novak, University of Calgary, Calgary, AB
Josée Parent, Montreal General Hospital, Montreal, QC
Lana Bistritz, University of Alberta, Edmonton, AB
Jason Yap, University of Alberta, Edmonton, AB