Wide social participation in prioritizing patients on waiting lists for joint replacement: a conjoint analysis.
OBJECTIVE
The aim was to develop a priority scoring system for patients on waiting lists for joint replacement based on a wide social participation, and to analyze the differences among participants.


METHODS
Conjoint analysis. Focus groups in combination with a nominal technique were employed to identify the priority criteria (N=36). A rank-ordered logit model was then applied for scoring estimations. Participants (N=860) represented: consultants, allied-health professionals, patients and their relatives, and the general population of Catalonia.


RESULTS
Clinical and social criteria were selected, and their relative importance (over 100 points) was: pain (33), difficulty in doing activities of daily living (21), disease severity (18), limitations on ability to work (10), having someone to look after the patient (9), being a caregiver (6), and recovery probability (4). Estimated criteria coefficients had the expected positive sign and all were statistically significant (P < 0.001). There were differences between groups; pain was rated higher by patients/relatives, and difficulty in doing activities was rated lower by patients/relatives and the general public. Most interaction terms for these criteria and groups were significant (P < 0.001). Consultants and allied-health professionals had the most similar prioritization pattern (r=0.97).


CONCLUSIONS
Both clinical and social criteria are considered for prioritization of joint replacement surgery from a wide social perspective. The preference among professional and social groups varies and this might impact the result of patient prioritization. A wide social participation for obtaining adequate prioritizing systems for patients on waiting lists is desirable.
Sampietro-Colom
L
L
Office for the Assessment of Innovation and New Technologies, Fundació Clínic, Barcelona, Spain. lsampiet@clinic.ub.es
Espallargues
M
M
Rodríguez
E
E
Comas
M
M
Alonso
J
J
Castells
X
X
Pinto
J L
JL
D000203:Activities of Daily Living; D000328:Adult; D019643:Arthroplasty, Replacement / Q000523:psychology; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011639:Public Opinion; D012959:Socioeconomic Factors; D014850:Waiting Lists