University of Calgary, Calgary, Alberta, Canada.
McMaster University, Hamilton, Ontario, Canada.
Osteoarthritis Cartilage. 2018 Apr;26(4):522-530. doi: 10.1016/j.joca.2018.01.008. Epub 2018 Feb 7.
Patients face significant waiting times for hip and knee total joint replacement (TJR) in publicly funded healthcare systems. We aimed to assess how surgeon selection and reputation affect patients' willingness to wait for TJR.
We assessed patient preferences using a discrete choice experiment questionnaire with 12 choice scenarios administered to patients referred for TJR. Based on qualitative research, pre- and pilot-testing, we characterized each scenario by five attributes: surgeon reputation, surgeon selection, waiting time to surgeon visit (initial consultation), waiting time to surgery, and travel time to hospital. Preferences were assessed using hierarchical Bayes (HB) analysis and evaluated for goodness-of-fit. We conducted simulation analyses to understand how patients value surgeon reputation and surgeon selection in terms of willingness to wait for surgeon visit and surgery.
Of 422 participants, 68% were referred for knee TJR. The most important attribute was surgeon reputation followed by waiting times, surgeon selection process and travel time. Patients appear willing to wait 10 months for a visit with an excellent reputation surgeon before switching to a good reputation surgeon. Patients in the highest pain category were willing to wait 7.3 months before accepting the next available surgeon, compared to 12 months for patients experiencing the least pain.
Our findings confirm that patients value surgeon reputation in the context of wait times and surgeon selection. We suggest opportunities to reduce wait times by explicitly offering the next available surgeon to increase patient choice, and by reporting surgeon performance to reduce potential misinformation about reputation.
在公共资助的医疗保健系统中，患者接受髋关节和膝关节全关节置换术（TJR）治疗需要等待很长时间。我们旨在评估外科医生的选择和声誉如何影响患者对 TJR 的等待意愿。
我们使用具有 12 个选择场景的离散选择实验问卷评估了患者的偏好，这些场景被分配给接受 TJR 治疗的患者。基于定性研究、预测试和试点测试，我们通过五个属性来描述每个场景：外科医生的声誉、外科医生的选择、与外科医生的初次就诊（初始咨询）的等待时间、手术等待时间和前往医院的旅行时间。使用分层贝叶斯（HB）分析评估偏好，并评估拟合优度。我们进行模拟分析，以了解患者在等待外科医生就诊和手术方面如何根据外科医生的声誉和选择来评估价值。
在 422 名参与者中，68%的人被推荐进行膝关节 TJR。最重要的属性是外科医生的声誉，其次是等待时间、外科医生的选择过程和旅行时间。患者愿意等待 10 个月，以便在选择声誉良好的外科医生之前与声誉极佳的外科医生预约就诊。处于最高疼痛类别的患者愿意等待 7.3 个月，然后再接受下一位可用的外科医生，而疼痛程度最低的患者则愿意等待 12 个月。
我们的研究结果证实，患者在等待时间和外科医生选择的背景下重视外科医生的声誉。我们建议通过明确提供下一位可用的外科医生来增加患者的选择机会，以及通过报告外科医生的表现来减少声誉方面的潜在错误信息，从而有机会减少等待时间。
