# The elicitation of patient preferences for hip replacement surgery: a discrete choice experiment

## TL;DR

This study explores how patients choose hospitals for hip replacement surgery based on quality information, finding that treatment quality and case volume are most important.

## Contribution

The study introduces a method to quantify patient preferences for hospital quality attributes in hip replacement surgery.

## Key findings

- Patients prioritize 'Quality of treatment' and 'Number of cases treated' when selecting hospitals for hip replacement.
- Attributes like 'EndoCert Certificate' and 'Recommendation from other patients' are less influential in hospital choice.
- No unobserved preference heterogeneity was found among HRC users for hospital quality attributes.

## Abstract

The calculation of aggregated composite measures is a widely used approach to reduce the amount of quality-related data on hospital report cards (HRCs). This study aims to elicit patient preferences for hospital choice concerning publicly available hospital quality information for total hip replacement surgery. The results may assist in the development of weighted composite measures for elective hip replacement, which facilitates a conscious selection of the hospital.

We collect primary survey data on a sample of 364 randomly selected users of the German HRC “Weisse Liste” (WL) (4/5 2023). The key attributes for hospital choice are based on the information provided in WL. We run various model specifications to identify patient preferences, allowing the analysis of unobserved preference heterogeneity.

Our sample consists of 177 respondents (mean age 56.46; 43.5% female). All attributes used are statistically significant for hospital choice (\documentclass[12pt]{minimal}
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\begin{document}$$p<0.01$$\end{document}p<0.01). Patients consider the “Quality of treatment” (26.95%; level range 1.734) and “Number of cases treated” (24.78%; level range 1.594) to be the most important. In contrast, “EndoCert Certificate” (17.50%; level range 1.126), “Equipment and qualification” (15.83%; level range 1.018), and “Recommendation from other patients” (14.94%; level range 0.960) remain less important. We find no evidence for unobserved heterogeneity regarding the preferences for hospital choice.

Based on our findings, HRC users value publicly available hospital quality information for elective hip replacement differently. These differences should be taken into account when calculating aggregated composite measures. Our results may allow the calculation of a weighted aggregate composite measure from the perspective of HRC users.

The online version contains supplementary material available at 10.1186/s12913-025-12393-6.