What publicly available quality metrics do hip and knee arthroplasty patients care about most when selecting a hospital in Maryland: a discrete choice experiment
Lyndsay M O’Hara,#1 Ilaria Caturegli,#2 Nathan N O’Hara,2 Robert V O’Toole,2 David F Dalury,3 Anthony D Harris,1 and Theodore T Manson2Hip Knee
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.
Link to article