Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0728, USA.
Clin Orthop Relat Res. 2013 Jun;471(6):1865-72. doi: 10.1007/s11999-012-2640-9.
The growth of consumer-directed health plans has sparked increased demand for information regarding the cost and quality of healthcare services, including total joint arthroplasty (TJA). However, the factors that influence patients' choice of provider when pursuing elective orthopaedic care, such as TJA, are poorly understood.
QUESTIONS/PURPOSES: We evaluated the factors patients consider when selecting an orthopaedic surgeon and hospital for TJA.
Two hundred fifty-one patients who sought treatment from either an academic or community-based orthopaedic practice for primary TJA completed a 37-item survey using a 5-point Likert scale rating ("unimportant" to "very important") regarding seven established clinical and nonclinical dimensions of care patients considered when selecting a provider and hospital.
Patients rated physician manner (average Likert, 4.7) and physician quality (eg, outcomes) (average Likert, 4.6) as most important in their selection of surgeon and hospital for TJA. Despite the expressed importance of surgeon and hospital quality, only 46% of patients were able to find useful information to compare outcomes among surgeons, and 47% for hospitals that perform TJA.
Our findings suggest physician manner and surgical outcomes are the most important considerations for patients when choosing a provider for elective TJA. Cost sharing is the least important criterion patients considered. Patients expressed high motivation to seek out provider quality information but indicated accessible and actionable sources of information are lacking. Future efforts should be directed at developing clinically relevant, easily interpretable, objective, risk-adjusted measures of physician and hospital quality.
消费者导向型健康计划的增长引发了人们对医疗服务成本和质量的需求增加，包括全关节置换术（TJA）。然而，对于选择接受择期骨科护理（如 TJA）的患者，其选择提供者的影响因素仍知之甚少。
问题/目的：我们评估了患者在选择骨科外科医生和医院进行 TJA 时考虑的因素。
251 名患者在学术或社区骨科诊所接受初次 TJA 治疗，他们使用 5 点李克特量表（“不重要”到“非常重要”）对七个已建立的临床和非临床护理维度进行评分，以评估他们在选择提供者和医院时考虑的因素。
患者将医生的态度（平均李克特，4.7）和医生的质量（例如，结果）（平均李克特，4.6）评为在选择 TJA 外科医生和医院时最重要的因素。尽管患者表达了对外科医生和医院质量的重视，但只有 46%的患者能够找到有用的信息来比较外科医生的结果，而 47%的患者可以找到进行 TJA 的医院的相关信息。
我们的研究结果表明，患者在选择 TJA 的提供者时，医生的态度和手术结果是最重要的考虑因素。成本分担是患者考虑的最不重要的标准。患者表示有很高的动力去寻找提供者质量信息，但表示缺乏易于获取和可操作的信息来源。未来的努力应致力于开发具有临床相关性、易于解释、客观、风险调整的医生和医院质量衡量标准。
