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Clin Orthop Relat Res. 2013 Jun;471(6):1865-72. doi: 10.1007/s11999-012-2640-9.

Factors that influence provider selection for elective total joint arthroplasty.

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Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0728, USA.



The growth of consumer-directed health plans has sparked increased demand for information regarding the cost and quality of healthcare services, including total joint arthroplasty (TJA). However, the factors that influence patients' choice of provider when pursuing elective orthopaedic care, such as TJA, are poorly understood.


We evaluated the factors patients consider when selecting an orthopaedic surgeon and hospital for TJA.


Two hundred fifty-one patients who sought treatment from either an academic or community-based orthopaedic practice for primary TJA completed a 37-item survey using a 5-point Likert scale rating ("unimportant" to "very important") regarding seven established clinical and nonclinical dimensions of care patients considered when selecting a provider and hospital.


Patients rated physician manner (average Likert, 4.7) and physician quality (eg, outcomes) (average Likert, 4.6) as most important in their selection of surgeon and hospital for TJA. Despite the expressed importance of surgeon and hospital quality, only 46% of patients were able to find useful information to compare outcomes among surgeons, and 47% for hospitals that perform TJA.


Our findings suggest physician manner and surgical outcomes are the most important considerations for patients when choosing a provider for elective TJA. Cost sharing is the least important criterion patients considered. Patients expressed high motivation to seek out provider quality information but indicated accessible and actionable sources of information are lacking. Future efforts should be directed at developing clinically relevant, easily interpretable, objective, risk-adjusted measures of physician and hospital quality.

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