3I-2 WHY ARE SO MANY PATIENTS DISSATISFIED WITH KNEE REPLACEMENT SURGERY? REFLECTIONS AND RESULTS FROM A MULTIPHASE MIXED METHODS STUDY IN BRITISH COLUMBIA

Tuesday, October 20, 2015: 10:45 AM
Grand Ballroom C (Hyatt Regency St. Louis at the Arch)

Stirling Bryan1, Laurie J Goldsmith2, Richard Sawatzky3, Valerie MacDonald4, Jennifer Davis1, Samar Hejazi5, Patrick McAllister6, Ellen Randall7, Jessica Shum1 and Nitya Suryaprakash1, (1)Centre for Clinical Epidemiology & Evaluation, Vancouver, BC, Canada, (2)Simon Fraser University, Burnaby, BC, Canada, (3)Trinity Western University, Langley, BC, Canada, (4)Fraser Health Authority, Burnaby, BC, Canada, (5)Fraser Health Authority, Surrey, BC, Canada, (6)Island Health, Victoria, BC, Canada, (7)School of Population and Public Health, Vancouver, BC, Canada
Purpose: Whilst total knee arthroplasty (TKA) is the most common joint replacement surgery in Canada, published research indicates dissatisfaction post-surgery in up to 20% of patients. This statistic is troubling, especially as the underlying problems and solutions remain unclear, but also offers potential for service improvement and efficiency gains. Our research team is currently investigating this question through a longitudinal mixed methods cohort study: Patient Experience of Arthroplasty of the Knee (PEAK).

    Method: Our project explores patient satisfaction, experience and outcomes quantitatively (using survey data collected at 6 and 12 months, and administrative data) and qualitatively (interviews conducted at 7 and 13 months post-surgery). A cohort of 515 patients has been established­—57 of which were purposefully sampled for the qualitative portion—with recruitment from all regions of British Columbia. A highly engaged patient cohort has been achieved, evidenced through very high response rates to our postal surveys (91% at 6 months, 88% at 12 months). To explain variation in survey-reported satisfaction, we used bivariate and multivariate ordered logistic regression using two-level (patient and health region) random intercept proportional odds models. The mixed methods frame for this project resulted from a team commitment to interdisciplinarity. Quantitative survey data have been used to inform sampling for the qualitative component, and qualitative data were used to support the quantitative analysis and interpretation. All team members are involved in regular qualitative and quantitative data discussions.

    Result: Our survey data indicate a dissatisfaction rate of approximately 15% at both 6 and 12 months. Key drivers of variation in survey-reported dissatisfaction include: pre-surgery patient expectations and mental health (particularly depression); and post-surgery health outcomes, most notably pain and functional limitations (e.g., stiffness, mobility, usual activities, etc.). The qualitative data are supportive and complementary to our quantitative findings, indicating the importance of personal and clinical support, particularly post-surgery. In addition, patients reported dissatisfaction with not being sufficiently forewarned about post-surgical pain and having insufficient interaction with their surgeon and the health care system post-surgery.

    Conclusion: These results indicate where the TKA process and the health care system might be able to provide better patient-centered care.  Areas highlighted include patient selection, and post-operative care and support, particularly challenging the boundaries of where the health care system ends its relationship with the patient.

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