Patient Preferences between Minimum Volume Thresholds and Nationwide Healthcare Provision: the Example of Total Knee Arthroplasty.

Abstract

The aim of this study is to investigate, whether patients in Germany are willing to travel a longer time to a certain hospital in order to receive a better treatment (lower 90-days mortality, lower risk of revision) in elective total knee arthroplasty. In addition, we analyzed which characteristics determined patient preference. The participants were recruited via random samples of registration offices and hospitals. All have undergone discrete choice experiments for the outcomes mortality and revision. Descriptive statistics were used to analyze the patient's preference. Logistic regression models were applied to identify characteristics that influence decision making. 71.7% (mortality) and 86.11% (revision) of the respondents are willing to travel a longer time in order to lower their surgical risk. The amount of people that are willing to do so is even larger in the subgroup recruited in the hospital (78.5% respectively 90.7%). The majority of the participants are willing to travel longer to lower their surgical risk for elective knee arthroplasty. It has to be considered, that the population under study might not be representative. Patient's preferences corresponds with the aim of introducing minimum volume thresholds. Future studies should focus on other indications and outcomes.