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Medical Decision Making
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Wide Social Participation in Prioritizing Patients on Waiting Lists for Joint Replacement: A Conjoint Analysis

L. Sampietro-Colom, MD, PhD

Office for the Assessment of Innovation and New Technologies, Fundació Clínic, Barcelona, Spain, lsampiet{at}clinic.ub.es, Catalan Agency for Health Technology Assessment and Research (CAHTA), Barcelona, Spain

M. Espallargues, MD, PhD

Catalan Agency for Health Technology Assessment and Research (CAHTA), Barcelona, Spain

E. Rodríguez, PhD

Department of Applied Economics, Universidad de Vigo, Vigo, Spain

M. Comas, BSc

Evaluation and Clinical Epidemiology Department, Hospital del Mar-IMAS, Barcelona, Spain, Health Services Research Unit, Institut Municipal d'Investigació Médica (IMIM-Hospital del Mar), Barcelona, Spain

J. Alonso, MD, PhD

Health Services Research Unit, Institut Municipal d'Investigació Médica (IMIM-Hospital del Mar), Barcelona, Spain, Universitat Autónoma de Barcelona, Barcelona, Spain

X. Castells, MD, PhD

Evaluation and Clinical Epidemiology Department, Hospital del Mar-IMAS, Barcelona, Spain, Health Services Research Unit, Institut Municipal d'Investigació Médica (IMIM-Hospital del Mar), Barcelona, Spain (MC, JA, XC)

J.L. Pinto, PhD

Centre for Research in Economy and Health (CRES), Universitat Pompeu Fabra, Barcelona, Spain

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). Conclusion. 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.

Key Words: priority setting • elective surgery • hip/knee replacement • conjoint analysis • preferences • social participation. (Med Decis Making 2008;28:554—566)

This version was published on July 1, 2008

Medical Decision Making, Vol. 28, No. 4, 554-566 (2008)
DOI: 10.1177/0272989X08315235
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