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What publicly available quality metrics do hip and knee arthroplasty patients care about most when selecting a hospital in Maryland: a discrete choice experiment.

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.

SUBMITTER: O'Hara LM

PROVIDER: S-EPMC6530433 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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What publicly available quality metrics do hip and knee arthroplasty patients care about most when selecting a hospital in Maryland: a discrete choice experiment.

O'Hara Lyndsay M LM Caturegli Ilaria I O'Hara Nathan N NN O'Toole Robert V RV Dalury David F DF Harris Anthony D AD Manson Theodore T TT

BMJ open 20190519 5

<h4>Objective</h4>To quantify which publicly reported hospital quality metrics have the greatest impact on a patient's simulated hospital selection for hip or knee arthroplasty.<h4>Design</h4>Discrete choice experiment.<h4>Setting</h4>Two university-affiliated orthopaedic clinics in the greater Baltimore area, Maryland, USA.<h4>Participants</h4>One hundred and twenty-eight patients who were candidates for total hip or knee arthroplasty.<h4>Primary and secondary outcome measures</h4>The effect an ...[more]

PMID: 31110108

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Project description:IntroductionThe legalization of recreational cannabis use can enable cancer survivors to manage aspects of their care with cannabinoids without medical authorization or stigmatization. However, the absence of medical guidance-from the scientific literature or the healthcare system-makes it difficult for survivors to reach informed decisions about their care.ObjectiveThis article outlines the qualitative research undertaken to design a discrete choice experiment (DCE) aimed at understanding Canadian cancer survivors' preferences for managing their cancer symptoms with cannabis in this complex socio-medical context.MethodsIn this study, we drew on previously published qualitative research (a literature review and interviews with cancer survivors) and the theory of planned behavior, holding weekly team meetings to review the qualitative data and identify initial attributes associated with medicinal cannabis consumption to inform the DCE design. The initial attributes were further assessed to determine whether they were sensitive to the Canadian context, modifiable to produce levels and trade-offs, and amenable to policy intervention, in order to form the DCE choice sets. The choice sets were tested via think-aloud exercises with members of the general population and included debriefing interviews. Think-aloud participants were recruited from patient groups and previous studies.ResultsBased on our review of the interview study, we identified the following attributes associated with selecting medicinal cannabis: effectiveness; chance of side effects; support from family, friends, and/or physicians; cost; and availability. Ability to perform everyday activities was added and monthly out-of-pocket cost was refined to render the DCE realistic to cancer survivors in the Canadian context. Revisions to the DCE instructions, terminology, and cost levels were made based on results from the think-aloud exercises (n = 10).ConclusionsThis qualitative study outlines the preference evidence collected regarding Canadian cancer survivors' decisions to manage their symptoms with cannabis to inform a DCE quantitative survey. It contributes to transparent reporting of qualitative work in DCE development and to understanding cancer survivors' preferences regarding medicinal cannabis consumption under legalization.

Project description:BackgroundNurse practitioners play a critical role in improving the access to care and in meeting the needs for health care. However, prior to the COVID-19 pandemic, the average turnover rate of nurse practitioners was 10 % with associated total direct cost that ranged from $85,832 to $114,919 for each episode of turnover in the United States. Little is known about the job preference of nurse practitioners and the cost savings to an organization that provides jobs with characteristics attractive to nurse practitioners.ObjectiveThe aim of this study was to identify the preferred job characteristics that are associated with nurse practitioners' job choices; and to determine the extent to which nurse practitioners would need to be compensated for practicing without these characteristics.DesignA two-stage design using a mixed method approach.Setting(s)The state of Georgia in the United States.Participants2757 nurse practitioners who were actively licensed were invited to participate. Of the 412 participants, 372 actively employed in Georgia were included in the analysis.MethodsA 2-stage discrete choice experiment was designed. Stage-1 was a qualitative design using a focus group to identify nurse practitioners' preferred job characteristics. Stage-2 was a quantitative design using survey distribution and analysis. A mixed logit model was used for ranking nurse practitioners' preferred job characteristics and the extent to which they would need to be compensated.ResultsOn average nurse practitioners were 47.4 years of age; the majority were female (90 %), white (75.3 %), and educated at the master's level (88.7 %). Participants did not value teams that were not very cohesive (β = -1.50); administration that was not very responsive and supportive (β = -1.04); being supervised by a physician (β = -0.58); not having their own panel of patients (β = -0.42); and not billing under their own National Provider Identifier (β = -0.18). Participants would need an increase in annual income of USD$21,780 for practicing in a not very cohesive team; USD$15,280 for practicing with a not very responsive administration; and USD$21,450 for being supervised by a physician.ConclusionsA cohesive, responsive, and supportive working environment and being able to practice independently are important characteristics for nurse practitioners when choosing a job. Healthcare managers should provide a workplace culture that reflects these preferred job characteristics to attract and retain nurse practitioners. Policymakers should consider reforming the scope of practice legislation to promote the independent practice of nurse practitioners.

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What publicly available quality metrics do hip and knee arthroplasty patients care about most when selecting a hospital in Maryland: a discrete choice experiment.

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What publicly available quality metrics do hip and knee arthroplasty patients care about most when selecting a hospital in Maryland: a discrete choice experiment.

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