Objective:To assess the impact of quality of care and other hospital information on patients' choices between hospitals. Methods: 665 former surgical patients were invited to respond to an Internet-based questionnaire including a choice-based conjoint analysis. Each patient was presented with 12 different comparisons of 2 hospitals, with each hospital characterized by 6 attributes containing 2 levels. Hospital attributes were included if frequently reported by patients as most important for future hospital choices. These included both general hospital information (e.g., atmosphere), information on quality of care (e.g., percentage of patients with "textbook outcome"), and surgery-specific information (e.g., possibility for minimally invasive procedure). Hierarchial Bayes estimation was used to estimate the utilities for each attribute level for each patient. Based on the ranges of these utilities, the relative importance of each hospital attribute was determined for each participant as a measure of the impact on patients' choices. Results: 308 (46.3%) questionnaires were available for analysis. Of the hospital attributes that patients considered, surgery-specific information on average had the highest relative importance (25.7 [23.9-27.5]), regardless of gender, age, and education. Waiting time and hospital atmosphere were considered least important. The attribute concerning the percentage of patients with "textbook outcomes" had the second greatest impact (18.3 [16.9-19.6]), which was similar for patients with different adverse outcome experience. Conclusions: Surgery-specific and quality of care information are more important than general information when patients choose between hospitals. I nformation on performance of hospitals is increasingly available within the public domain in various countries worldwide. 1 Such information is thought to improve patients' choice and quality of care. However, patients do not seem to use quality information for their hospital choice. Marshall and others, 2 for instance, showed in their literature review of the period 1986-1999 that patients rarely searched for information about hospital performance, that they did not understand or trust information they did find, and that it had a small (although increasing during the time period reviewed) impact on their decision making. More recently, Faber and others 3 concluded in their systematic review that there is limited evidence about the effectiveness of quality information on consumer choice. Furthermore, Fung and others 4 showed in their review that the effect of public reporting on the outcomes of patient care, improvement of patient safety, and patient centeredness remains uncertain, since rigorous evaluation of many reporting systems is lacking. Possible explanations for these findings are that there is too much information, it is not the information patients want, or other information prevails when choices are made.Increased competition between hospitals based on quality is one of the central themes in the health care insur...
Study objective-To assess the size of mortality diVerentials in men by social class in Scotland as compared with England and Wales, and to analyse the time trends in these diVerentials. Socioeconomic mortality diVerences in England and Wales have increased over the past 40 years. Subjects-Men from England and1-5 Recently, increased attention has been given to the international variation in the size of mortality diVerences associated with socioeconomic position. Kunst and Mackenbach show that countries diVer in the size of their socioeconomic mortality diVerences, with small diVerences being observed in Norway and Denmark and large diVerences in France. 6 Scotland is known to have higher death rates than England and Wales. Carstairs and Morris argued that this higher mortality around the 1981 census is because of the much higher levels of deprivation in Scotland as compared with England and Wales.7 In another study it was shown that the mortality diVerentials between the west of Scotland and the south of England were largely explained by age, height, lung function, socioeconomic status, and smoking. 8 The relative magnitude of socioeconomic mortality diVerentials within Scotland and England and Wales has not been examined previously, however.The purpose of this study is to assess the magnitude of the mortality diVerences by social class in Scotland as compared with England and Wales over the period 1951 to 1981, to determine whether the higher overall mortality rate in Scotland is accompanied by greater socioeconomic mortality diVerentials within Scotland. We investigate which causes of death have contributed to increasing social class mortality diVerences and whether these were diVerent in Scotland than in England and Wales. MethodsAll analyses were restricted to men aged 15 to 64 years of age because of diYculties in comparing social class measures in women, based on their own or their spouses occupation, over time. The population of 65 years and older was excluded, because the meaning of social class coded on death certificates for
Aims Although bone cement is the primary mode of fixation in total knee arthroplasty (TKA), cementless fixation is gaining interest as it has the potential of achieving lasting biological fixation. By 3D printing an implant, highly porous structures can be manufactured, promoting osseointegration into the implant to prevent aseptic loosening. This study compares the migration of cementless, 3D-printed TKA to cemented TKA of a similar design up to two years of follow-up using radiostereometric analysis (RSA) known for its ability to predict aseptic loosening. Methods A total of 72 patients were randomized to either cementless 3D-printed or a cemented cruciate retaining TKA. RSA and clinical scores were evaluated at baseline and postoperatively at three, 12, and 24 months. A mixed model was used to analyze the repeated measurements. Results The mean maximum total point motion (MTPM) at three, 12, and 24 months was 0.33 mm (95% confidence interval (CI) 0.25 to 0.42), 0.42 mm (95% CI 0.33 to 0.51), and 0.47 mm (95% CI 0.38 to 0.57) respectively in the cemented group, versus 0.52 mm (95% CI 0.43 to 0.63), 0.62 mm (95% CI 0.52 to 0.73), and 0.64 mm (95% CI 0.53 to 0.75) in the cementless group (p = 0.003). However, using three months as baseline, no difference in mean migration between groups was found (p = 0.497). Three implants in the cemented group showed a > 0.2 mm increase in MTPM between one and two years of follow-up. In the cementless group, one implant was revised due to pain and progressive migration, and one patient had a liner-exchange due to a deep infection. Conclusion The cementless TKA migrated more than the cemented TKA in the first two-year period. This difference was mainly due to a higher initial migration of the cementless TKA in the first three postoperative months after which stabilization was observed in all but one malaligned and early revised TKA. Whether the biological fixation of the cementless implants will result in an increased long-term survivorship requires a longer follow-up. Cite this article: Bone Joint J 2020;102-B(8):1016–1024.
BackgroundIntravenous thrombolysis (IVT) plays a prominent role in the treatment of acute ischemic stroke (AIS). The sooner IVT is administered, the higher the odds of a good outcome. Therefore, registering the in-hospital time to treatment with IVT, i.e. the door-to-needle time (DNT), is a powerful way to measure quality improvement. The aim of this study was to identify determinants that are associated with extended DNT.MethodsPatients receiving IVT in 2015 and 2016 registered in the Dutch Acute Stroke Audit were included. DNT and onset-to-door time (ODT) were dichotomized using the median (i.e. extended DNT) and the 90th percentile (i.e. severely extended DNT). Logistic regression was performed to identify determinants associated with (severely) extended DNT/ODT and its effect on in-hospital mortality. A linear model with natural spline was used to investigate the association between ODT and DNT.ResultsIncluded were 9518 IVT treated patients from 75 hospitals. Median DNT was 26 min (IQR 20–37). Determinants associated with a higher likelihood of extended DNT were female sex (OR 1.17, 95% CI 1.05–1.31) and admission during off-hours (OR 1.12, 95% CI 1.01–1.25). Short ODT correlated with longer DNT, whereas longer ODT correlated with shorter DNT. Young age (OR 1.38, 95% CI 1.07–1.76) and admission to a comprehensive stroke center (OR 1.26, 1.10–1.45) were associated with severely extended DNT, which was associated with in-hospital mortality (OR 1.54, 95%CI 1.19–1.98).ConclusionsEven though DNT in the Netherlands is short compared to other countries, lowering the DNT may be achievable by focusing on specific subgroups.
The tibial components of PA-coated TKAs showed more overall migration compared with the tibial components of cemented TKAs. However, analysis showed that this difference was caused by higher migration of PA-coated components in the first three months, after which a stable migration pattern was observed. Clinically, there was no significant difference in outcome between the groups. Cite this article: 2017;99-B:1467-76.
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