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Decision Aid Implementation and Patients’ Preferences for Hip and Knee Osteoarthritis Treatment: Insights from the High Value Healthcare Collaborative

Authors Hurley VB, Wang Y, Rodriguez HP, Shortell SM, Kearing S, Savitz LA

Received 23 August 2019

Accepted for publication 7 December 2019

Published 6 January 2020 Volume 2020:14 Pages 23—32


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Vanessa B Hurley,1 Yue Wang,2 Hector P Rodriguez,3 Stephen M Shortell,3 Stephen Kearing,4 Lucy A Savitz5

1Health Systems Administration, Georgetown University, Washington, DC 20057, USA; 2Tile, San Mateo, CA 94403, USA; 3Health Policy and Management, University of California, Berkeley School of Public Health, Berkeley, CA 94720, USA; 4High Value Healthcare Collaborative, Hanover, NH 03755, USA; 5Center for Health Research (Northwest and Hawaii), Health Research, Kaiser Permanente, Portland, OR 97227, USA

Correspondence: Vanessa B Hurley
Health Systems Administration, Georgetown University, St. Mary’s Hall 231, 3700 Reservoir Road, NW, Washington, DC 20057, USA
Tel +1 202-687-4209

Background: Shared decision making (SDM) research has emphasized the role of decision aids (DAs) for helping patients make treatment decisions reflective of their preferences, yet there have been few collaborative multi-institutional efforts to integrate DAs in orthopedic consultations and primary care encounters.
Objective: In the context of routine DA implementation for SDM, we investigate which patient-level characteristics are associated with patient preferences for surgery versus medical management before and after exposure to DAs. We explored whether DA implementation in primary care encounters was associated with greater shifts in patients’ treatment preferences after exposure to DAs compared to DA implementation in orthopedic consultations.
Design: Retrospective cohort study.
Setting: 10 High Value Healthcare Collaborative (HVHC) health systems.
Study participants: A total of 495 hip and 1343 adult knee osteoarthritis patients who were exposed to DAs within HVHC systems between July 2012 to June 2015.
Results: Nearly 20% of knee patients and 17% of hip patients remained uncertain about their treatment preferences after viewing DAs. Older patients and patients with high pain levels had an increased preference for surgery. Older patients receiving DAs from three HVHC systems that transitioned DA implementation from orthopedics into primary care had lower odds of preferring surgery after DA exposure compared to older patients in seven HVHC systems that only implemented DAs for orthopedic consultations.
Conclusion: Patients’ treatment preferences were largely stable over time, highlighting that DAs for SDM largely do not necessarily shift preferences. DAs and SDM processes should be targeted at older adults and patients reporting high pain levels. Initiating treatment conversations in primary versus specialty care settings may also have important implications for engagement of patients in SDM via DAs.

Keywords: shared decision making, patient engagement, patient preferences, quality of care, health systems, collaborative learning

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