Equity adjustor for surgical wait lists stopped

NEWS - eHealthNews.nz editor Rebecca McBeth

Use of an algorithm to reduce inequity in non-urgent surgical waitlists is being stopped, despite an independent review recommendation that its use should continue.

eHealthNews reported in June 2023 that a team at Health New Zealand Te Whatu Ora Te Toka Tumai Auckland had developed an Equity Adjustor Tool to prioritise patients who have been waiting a long time for surgery.

The algorithm covers six areas with different weightings; clinical specialty; clinical priority, time spent on the waitlist, geographic location (isolated areas), ethnicity (specifically Māori or Pacific people) and deprivation level.

Development of the tool included data and analytics staff, the Māori health team, Pacific health team, and surgical services leadership. It was rolled out across all surgical services at Te Toka Tumai and in the Northern region. The Southern district also developed and rolled out a similar tool.

Dawson Ward, acting director adult surgical, said in June 2023, “we have demonstrated by the use of data that this is the right thing to do and is getting the results we want, so there is a lot of enthusiasm to roll it out further”.

However, use of the adjustor became highly politicised, and an independent review panel was asked to look at its implementation, chaired by Rod Jackson.

The panel’s report found that the benefits of the tools were inconclusive, but that they “could have been strengthened with better quality data, and alignment with best practice algorithm development”.

The panel made six recommendations which are that; action on demonstrated health inequities is legally and ethically justifiable; a consistent planned care action plan must be developed and mandated; and the action plan must address unacceptable variation in receipt of planned care.

It also recommended that; development and implementation must consider the right team and approach; and until then (and subject to conditions), the current tools should continue; also t hat co-benefits of equity interventions should be recognised and measured.

Health NZ says it agrees with all of these except the recommendation that the tools should continue to be used while evolved. 

“Health NZ considers a fundamental relook is required, not a simple evolution of the tools that the evaluation found were not robust,” says chief clinical officer Richard Sullivan.

The Southern and Northern regions have already stopped using the tool and Te Toku Tumai Auckland will now stop and “will revert to pre-existing waitlist management systems”.

“Should any new tool(s) or processes be developed, this will be done in line with the findings of the evaluation and would be rigorously assessed,” he says.

“No decision to adopt a new tool or process has been taken at this time. We will take the time we need to undertake robust assessment work on whether a new tool should be put in place.”

Greg Williams, interim chief digital officer, told eHealthNews in June 2023 that the Covid-19 pandemic had a negative impact on equity globally so it was hugely beneficial to have the equity adjustor in place to help address the problem.

“By the time patients engage with our part of the system, there is already a number of entrenched inequities which have led to that point, so this calculation is trying to undo some of the upstream inequity,” he said.

The panel’s report acknowledges that there is substantial variation in waiting list management across the country and says the outcome of the status quo systems in use is “not neutral”, with inequities present at each stage of the broader planned care pathway.

However, evaluating the status quo tools, such as the Clinical Priority Assessment Criteria (CPAC), was outside the scope of the Review.

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