Rehabilitation settings after joint replacement: an application of multiattribute preference elicitation.

While advances in medical treatment and technologies have the potential to improve the delivery of health care, their use typically involves making multiple, complex decisions. Patients and their medical providers may share in the decision-making processes and balance a variety of criteria and/or attributes in the pursuit of improved health. This necessitates a stronger understanding of the role of human behavior in health care processes and presents a timely opportunity to use decision analysis tools to contribute to this important aspect of health care operations. This article reports on the application of multiattribute preference elicitation to identify postsurgical rehabilitation setting options for elective hip and knee replacement patients and their discharge planning team prior to placement in these settings. These preferences are analyzed to identify trends in emphases across patients and the discharge planning team, including a comparison with actual outcomes to determine the extent of congruence with each other, an important component of patient-centered care. Variances are identified in what patients and the discharge planning team expected and what actually happened. Reasons for these variances are discussed.