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