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  • 1
    Online Resource
    Online Resource
    What publicly available quality metrics do hip and knee arthroplasty patients care about most when selecting a hospital in Maryland: a discrete choice experiment
    BMJ ; 2019
    In:  BMJ Open Vol. 9, No. 5 ( 2019-05), p. e028202-
    Details
    In: BMJ Open, BMJ, Vol. 9, No. 5 ( 2019-05), p. e028202-
    Abstract: To quantify which publicly reported hospital quality metrics have the greatest impact on a patient’s simulated hospital selection for hip or knee arthroplasty. Design Discrete choice experiment. Setting Two university-affiliated orthopaedic clinics in the greater Baltimore area, Maryland, USA. Participants One hundred and twenty-eight patients who were candidates for total hip or knee arthroplasty. Primary and secondary outcome measures The effect and magnitude of acceptable trade-offs between publicly reported hospital quality parameters on patients’ decision-making strategies using a Hierarchical Bayes model. Results Publicly reported information on patient perceptions of attention to alleviation of postoperative pain had the most influence on simulated hospital choice (20.7%), followed by methicillin-resistant Staphylococcus aureus (MRSA) rates (18.8%). The understandability of the discharge instructions was deemed the least important attribute with a relative importance of 6.9%. Stratification of these results by insurance status and duration of pain prior to surgery revealed that patient demographics and clinical presentation affect the decision-making paradigm. Conclusions Publicly available information regarding hospital performance is of interest to hip and knee arthroplasty patients. Patients are willing to accept suboptimal understanding of discharge instructions, lower hospital ratings and suboptimal cleanliness in exchange for better postoperative pain management, lower MRSA rates, and lower complication rates.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2018-028202
    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 2599832-8
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  • 2
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    Online Resource
    Patient preferences for physical therapy programs after a lower extremity fracture: a discrete choice experiment
    BMJ ; 2023
    In:  BMJ Open Vol. 13, No. 10 ( 2023-10), p. e072583-
    Details
    In: BMJ Open, BMJ, Vol. 13, No. 10 ( 2023-10), p. e072583-
    Abstract: To quantify patients’ preferences for physical therapy programmes after a lower extremity fracture and determine patient factors associated with preference variation. Design Discrete choice experiment. Setting Level I trauma centre. Participants One hundred fifty-one adult (≥18 years old) patients with lower extremity fractures treated operatively. Intervention Patients were given hypothetical scenarios and asked to select their preferred therapy course when comparing cost, mobility, long-term pain, session duration, and treatment setting. Main outcome measures A multinomial logit model was used to determine the relative importance and willingness to pay for each attribute. Results Mobility was of greatest relative importance (45%, 95% CI: 40% to 49%), more than cost (23%, 95% CI: 19% to 27%), long-term pain (19%, 95% CI: 16% to 23%), therapy session duration (12%, 95% CI: 9% to 5%) or setting (1%, 95% CI: 0.2% to 2%). Patients were willing to pay US$142 more per session to return to their preinjury mobility level (95% CI: US$103 to US$182). Willingness to pay for improved mobility was higher for women, patients aged 70 years and older, those with bachelor’s degrees or higher and those living in less-deprived areas. Patients were willing to pay US$72 (95% CI: US$50 to US$93) more per session to reduce pain from severe to mild. Patients were indifferent between formal and independent home therapy (willingness to pay: −US$12, 95% CI: −US$33 to US$9). Conclusions Patients with lower extremity fractures highly value recovering mobility and are willing to pay more for postoperative physical therapy programmes that facilitate returning to their pre-injury mobility level. These patient preferences might be useful when prescribing and designing new techniques for postoperative therapy.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2023-072583
    DOI: 10.1136/bmjopen-2023-072583.supp1
    DOI: 10.1136/bmjopen-2023-072583.supp2
    Language: English
    Publisher: BMJ
    Publication Date: 2023
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  • 3
    Online Resource
    Online Resource
    Patient preferences for nutritional supplementation to improve fracture healing: a discrete choice experiment
    BMJ ; 2018
    In:  BMJ Open Vol. 8, No. 4 ( 2018-04), p. e019685-
    Details
    In: BMJ Open, BMJ, Vol. 8, No. 4 ( 2018-04), p. e019685-
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2017-019685
    DOI: 10.1136/bmjopen-2017-019685.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2018
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  • 4
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    Online Resource
    Which orthopaedic trauma patients are likely to refuse to participate in a clinical trial? A latent class analysis
    BMJ ; 2019
    In:  BMJ Open Vol. 9, No. 10 ( 2019-10), p. e032631-
    Details
    In: BMJ Open, BMJ, Vol. 9, No. 10 ( 2019-10), p. e032631-
    Abstract: The study aimed to assess systematic differences in the characteristics of patients that consented for the trial compared with the broader pool of eligible patients in a large, pragmatic orthopaedic trauma trial. Design A retrospective observational study performed from April 2017 to March 2018. Setting Academic trauma centre in Baltimore, USA. Participants There were 642 eligible adult trial participants with an operative fracture to the appendicular skeleton and were indicated for blood clot prophylaxis. The median age of the sample was 50 years (IQR: 31–63), and 60% were male. Primary outcome measure The primary outcome was the refusal to enrol in the trial. Demographic and injury covariates were included in iterations of latent class models. The final model was selected based on a minimum Bayesian information criterion. Results The final model identified three clusters with five covariates predictive of cluster membership (age, neighbourhood-based socioeconomic status, alcohol use, multiple fractures, multiple surgeries). The three clusters were associated with 22% (Cluster 1), 38% (Cluster 2) and 62% (Cluster 3) refusal rates, respectively. Members of Cluster 3 (n=84) were most commonly between 66 and 80 years of age (49% vs 6% (Cluster 1) and 21% (Cluster 2)), of high neighbourhood-based socioeconomic status (85% vs 63% (Cluster 1) and 8% (Cluster 2)), with isolated fractures (100% vs 80% (Cluster 1) and 92% (Cluster 2)), and were less likely to have multiple surgeries compared with the other clusters (28% vs 47% (Cluster 1) and 35% (Cluster 2)). Conclusion In this study, the likelihood of refusing to participate in the trial ranged from 22% to 62% in the three identified clusters. Elderly age, high socioeconomic status, and less severe injuries defined the cluster that was most likely to refuse trial participation. Trial registration number NCT02984384 .
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2019-032631
    Language: English
    Publisher: BMJ
    Publication Date: 2019
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  • 5
    Online Resource
    Online Resource
    Is safe surgery possible when resources are scarce?
    BMJ ; 2015
    In:  BMJ Quality & Safety Vol. 24, No. 7 ( 2015-07), p. 432-434
    Details
    In: BMJ Quality & Safety, BMJ, Vol. 24, No. 7 ( 2015-07), p. 432-434
    Abstract: The greatest burden of surgical disease exists in low- and middle-income countries, where the quality and safety of surgical treatment cause major challenges. Securing necessary and appropriate medical supplies and infrastructure remains a significant and under-recognised limitation to providing safe and high-quality surgical care in these settings. The majority of surgical instruments are sold in high-income countries. Limited market pressures lead to superfluous designs and inflated costs for these devices. This context creates an opportunity for frugal innovation—the search for designs that will enable low-cost care without compromising quality. Although progressive examples of frugal surgical innovations exist, policy innovation is required to augment design pathways while fostering appropriate safety controls for prospective devices. Many low-cost, high-quality medical technologies will increase access to safe surgical care in low-income countries and have widespread applicability as all countries look to reduce the cost of providing care, without compromising quality.
    Type of Medium: Online Resource
    ISSN: 2044-5415 , 2044-5423
    URL: Article
    DOI: 10.1136/bmjqs-2015-004377
    Language: English
    Publisher: BMJ
    Publication Date: 2015
    detail.hit.zdb_id: 2592912-4
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  • 6
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    Online Resource
    PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT): a randomised pragmatic trial protocol comparing aspirin versus low-molecular-weight heparin for blood clot prevention in orthopaedic trauma patients
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 3 ( 2021-03), p. e041845-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 3 ( 2021-03), p. e041845-
    Abstract: Patients who sustain orthopaedic trauma are at an increased risk of venous thromboembolism (VTE), including fatal pulmonary embolism (PE). Current guidelines recommend low-molecular-weight heparin (LMWH) for VTE prophylaxis in orthopaedic trauma patients. However, emerging literature in total joint arthroplasty patients suggests the potential clinical benefits of VTE prophylaxis with aspirin. The primary aim of this trial is to compare aspirin with LMWH as a thromboprophylaxis in fracture patients. Methods and analysis PREVENT CLOT is a multicentre, randomised, pragmatic trial that aims to enrol 12 200 adult patients admitted to 1 of 21 participating centres with an operative extremity fracture, or any pelvis or acetabular fracture. The primary outcome is all-cause mortality. We will evaluate non-inferiority by testing whether the intention-to-treat difference in the probability of dying within 90 days of randomisation between aspirin and LMWH is less than our non-inferiority margin of 0.75%. Secondary efficacy outcomes include cause-specific mortality, non-fatal PE and deep vein thrombosis. Safety outcomes include bleeding complications, wound complications and deep surgical site infections. Ethics and dissemination The PREVENT CLOT trial has been approved by the ethics board at the coordinating centre (Johns Hopkins Bloomberg School of Public Health) and all participating sites. Recruitment began in April 2017 and will continue through 2021. As both study medications are currently in clinical use for VTE prophylaxis for orthopaedic trauma patients, the findings of this trial can be easily adopted into clinical practice. The results of this large, patient-centred pragmatic trial will help guide treatment choices to prevent VTE in fracture patients. Trial registration number NCT02984384 .
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-041845
    Language: English
    Publisher: BMJ
    Publication Date: 2021
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  • 7
    Online Resource
    Online Resource
    Patient preferences for venous thromboembolism prophylaxis after injury: a discrete choice experiment
    BMJ ; 2017
    In:  BMJ Open Vol. 7, No. 8 ( 2017-08), p. e016676-
    Details
    In: BMJ Open, BMJ, Vol. 7, No. 8 ( 2017-08), p. e016676-
    Abstract: Limited evidence for the optimal venous thromboembolism (VTE) prophylaxis regimen in orthopaedic trauma leads to variability in regimens. We sought to delineate patient preferences towards cost, complication profile, and administration route (oral tablet vs. subcutaneous injection). Design Discrete choice experiment (DCE). Setting Level 1 trauma center in Baltimore, USA. Participants 232 adult trauma patients (mean age 47.9 years) with pelvic or acetabular fractures or operative extremity fractures. Primary and secondary outcome measures Relative preferences and trade-off estimates for a 1% reduction in complications were estimated using multinomial logit modelling. Interaction terms were added to the model to assess heterogeneity in preferences. Results Patients preferred oral tablets over subcutaneous injections (marginal utility, 0.16; 95% CI: 0.11 - 0.21, P 〈 0.0001). Preferences changed in favor of subcutaneous injections with an absolute risk reduction of 6.98% in bleeding, 4.53% in wound complications requiring reoperation, 1.27% in VTE, and 0.07% in death from pulmonary embolism (PE). Patient characteristics (sex, race, type of injury, time since injury) affected patient preferences ( P 〈 0.01). Conclusions Patients preferred oral prophylaxis and were most concerned about risk of death from PE. Furthermore, the findings estimated the trade-offs acceptable to patients and heterogeneity in preferences for VTE prophylaxis.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2017-016676
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2599832-8
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