PONE-D-24-48992Protocol: Waiting time and ways of accessing specialized health services in public hospitals in Ecuador.PLOS ONE

Dear Dr. Armijos Briones,

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: In general, the protocol meets the required publication criteria, has an identified and justified research question, has current approval from an ethics committee, declares funding, includes preliminary results of a pilot test, has not yet been data collected for the study, and the place where these can be consulted publicly once they are available has been contemplated, however, some important points should be worked on before being published.

1. The variable “waiting time” is central to the study; previous publications have obtained this information from hospital records (1, 2), but this protocol proposes asking patients directly without verifying the data, which has the risk that the data is biased by the patients' memory: Is this bias will be controlled in some way? This is relevant since it has been reported that patients tend to overestimate the waiting time (3) which could lead to biased conclusions. The recommendation is to at least mention this bias as a limitation, taking into account its implication in the conclusions.

2. The other variable of interest “Form of access to the hospital” is subject to information bias since patients could lie about it when their entry has not been through a “standardized” route; this is controlled by emphasizing the confidentiality of the data to the people interviewed, however, it is a latent bias of which there is no certainty that it can be eliminated, so it must be mentioned in the limitations with the actions taken to reduce it.

3. The proposed statistical model does not seem to be correct. In the analysis section (page 17) it is mentioned that the variable “Form of Access” will be taken as dependent, however, how the study is planned, the “Form of Access” is the independent variable that is expected to influence in the “waiting time” which is the dependent variable. Therefore, a more appropriate model than the logistic one would be multiple linear regression, in which the other sociodemographic variables of interest could be included, as long as the assumptions of the model are met.

4. Regarding the questionnaire, the objective of asking questions 31 and 32 is not clear. They are sensitive questions that could make the person interviewed uncomfortable and do not seem to be directly related to the project, so it is recommended that the reason why they were included be justified, or otherwise discarded from the questionnaire.

5. It is not clear if section 3 of the questionnaire was also piloted. As it is the section that contains the variables of greatest interest in the study, it is recommended to pilot it, and if it has already been done, it is recommended to report the findings found.

6. General comments: On page 2, paragraph 2, line 8, the phrase “According to the results” is repeated; A protocol does not have a discussion section since results have not yet been obtained, so it is recommended to change the subtitle on page 19 to “Justification.”

References

1. Zhang, Hui PhDa; Ma, Weimin PhDa,*; Zhou, Shufen MDb; Zhu, Jingjing MDc; Wang, Li MDd; Gong, Kaixin MDa. Effect of waiting time on patient satisfaction in outpatient: An empirical investigation. Medicine 102(40):p e35184, October 06, 2023. | DOI: 10.1097/MD.0000000000035184

2. Ogawa T, Tachibana T, Yamamoto N, Udagawa K, Kobayashi H, Fushimi K, Yoshii T, Okawa A, Jinno T. Patient body mass index modifies the association between waiting time for hip fracture surgery and in-hospital mortality: A multicenter retrospective cohort study. J Orthop Sci. 2022 Nov;27(6):1291-1297. doi: 10.1016/j.jos.2021.07.015. Epub 2021 Aug 13. PMID: 34393026.

3. Thompson DA, Yarnold PR, Adams SL, Spacone, AB: How accurate are waiting time perceptions of patients in the emergency department? Ann Emerg Med 1996 28:652-656

Reviewer #2: Suggestion:

In the background section, it would be helpful to the readers if it briefly describes the health system in Ecuador.

Minor observations:

In the abstract, the last sentence repeats, "According to the results."

Table 2 the answer to the variable "sex," It would be better to use "hombre y mujer."

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Reviewer #1: No

Reviewer #2: Yes:  Samuel Gutierrez-Barreto

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Protocol: Waiting time and ways of accessing specialized health services in public hospitals in Ecuador.

PONE-D-24-48992R1

Dear Dr. Armijos Briones,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Juan Pablo Gutierrez

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: No

Reviewer #2: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: In general, the protocol meets the required publication criteria, has an identified and justified research question, has current approval from an ethics committee, declares funding, includes preliminary results of a pilot test, has not yet been data collected for the study, and the place where these can be consulted publicly once they are available has been contemplated. Also, the previous comments have been satisfactorily answered by the authors.

Reviewer #2: All the suggestions have been addressed. I have no more suggestions on this protocol.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

Reviewer #2: No

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