ANN ARBOR, MI — Patient-reported outcome measures are increasingly integrated into quality assessments following total joint arthroplasty (TJA), but patient perceptions of quality paired with the phase of surgical care has not been described, according to a new report.
The purpose of the study led by the University of Michigan and including participation from the VA Palo Alto, CA, Healthcare System, was to assess how TJA patients perceive measures of quality of care and assess whether these perceptions change based on the phase of care.
For the study published in BMC Musculoskeletal Disorders, patients who had undergone a TJA within the past two years or had a scheduled TJA within the next 6 months completed a questionnaire designed using best-worst scaling, a method used to measure individuals’ priorities by asking participants to make repeated selections of the best and worst items in a series of subsets of items. The researchers calculated subanalyses to compare each phase of care (preoperative, short term postoperative, and long term postoperative).1
Of the 153 patients completing the questionnaire, 36 were preoperative, 55 were short term postoperative and 62 were long term postoperative.
Patients placed the highest value on:
- improving activities of daily living (β = 1.03, CI = 0.90-1.16),
- decreasing pain (β = 0.65, CI = 0.53-0.76) and
- avoiding reintervention (β = 0.64, CI = 0.52-0.76).
“Decreasing pain ranked as a higher priority preoperatively compared to short term postoperatively, and subsequently increased in priority again after 6 months,” the authors noted. “Avoiding reintervention was less important to patients preoperatively compared to postoperatively. Avoiding complications was more important to patients preoperatively compared to postoperatively.”
The researchers concluded that matching outcome assessments with how patients assess their quality of care throughout the TJA recovery process “can inform phase-specific quality improvement initiatives and value definitions. Activities of daily living should be measured across phases of care and into long-term recovery. TJA value dashboards should align with these patient-driven perceptions of quality.”
- Lemos JL, Welch JM, Amanatullah DF, Shapiro LM, Harris AHS, Kamal RN. Time-dependent, patient-centered perceptions of quality measures for total joint arthroplasty: a cross-sectional, choice modeling study. BMC Musculoskelet Disord. 2025 Jan 13;26(1):41. doi: 10.1186/s12891-025-08284-w. PMID: 39806343; PMCID: PMC11727673.
