Article Text
PDF
Abstract
Objective To quantify which publicly reported hospital quality metrics have the greatest impact on a patient’s simulated hospital selection for hip or knee arthroplasty.
Design Discrete choice experiment.
Setting Two university-affiliated orthopaedic clinics in the greater Baltimore area, Maryland, USA.
Participants One hundred and twenty-eight patients who were candidates for total hip or knee arthroplasty.
Primary and secondary outcome measures The effect and magnitude of acceptable trade-offs between publicly reported hospital quality parameters on patients’ decision-making strategies using a Hierarchical Bayes model.
Results Publicly reported information on patient perceptions of attention to alleviation of postoperative pain had the most influence on simulated hospital choice (20.7%), followed by methicillin-resistant Staphylococcus aureus (MRSA) rates (18.8%). The understandability of the discharge instructions was deemed the least important attribute with a relative importance of 6.9%. Stratification of these results by insurance status and duration of pain prior to surgery revealed that patient demographics and clinical presentation affect the decision-making paradigm.
Conclusions Publicly available information regarding hospital performance is of interest to hip and knee arthroplasty patients. Patients are willing to accept suboptimal understanding of discharge instructions, lower hospital ratings and suboptimal cleanliness in exchange for better postoperative pain management, lower MRSA rates, and lower complication rates.
- patient preferences
- hospital quality metrics
- total hip and knee arthroplasty
- discrete choice experiment
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Footnotes
LMO’H and IC contributed equally.
Contributors LMO and ADH conceived the study. LMO, IC, NNO, RVO, DFD, ADH and TTM had input into the design of the study. LMO collected the focus group data and IC collected the discrete choice questionnaires. NNO and LMO analysed the data. LMO, IC and NNO interpreted the data. LMO and IC drafted the manuscript. NNO, RVO, DFD, ADH and TTM revised it critically for important intellectual content. All authors approved the final version to be published. All authors agree to be accountable for all aspects of the work. LMO and IC contributed equally to this paper.
Funding This work was supported by 5K24AI079040-05 (ADH) from the National Institutes of Health (NIH), and the Banting Postdoctoral Fellowship Program administered by the Government of Canada (LMO).
Competing interests None declared.
Ethics approval This study was reviewed by the University of Maryland School of Medicine Institutional Review Board (HP-00058264) and was deemed exempt from regulation based on the nature of the research.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Dataset available on written email request to authors.
Patient consent for publication Not required.