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. 2018 May;27(5):347-354.
doi: 10.1136/bmjqs-2017-007019. Epub 2017 Nov 24.

Increasing the Use of Patient Decision Aids in Orthopaedic Care: Results of a Quality Improvement Project

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Increasing the Use of Patient Decision Aids in Orthopaedic Care: Results of a Quality Improvement Project

Mahima Mangla et al. BMJ Qual Saf. .

Abstract

Objective: To integrate patient decision aid (DA) delivery to promote shared decision-making and provide more patient-centred care within an orthopaedic surgery department for treatment of hip and knee osteoarthritis, lumbar herniated disc and lumbar spinal stenosis.

Methods: Different strategies were used across three distinct phases to promote DA delivery. First, we used a quality improvement bonus to generate awareness and interest in the DAs among specialists. Second, we adapted the electronic referral management system to enable DA orders at referral to a specialist. Third, we engaged clinic staff and specialists to design workflows that promoted DA delivery. We tracked the number of patients who received a DA, who ordered the DA, and collected usage data from a subset of patients. Our target was to reach 60% of patients with DAs.

Results: In phase 1, 28% (43/155) of spine patients and 37% (114/308) of hip/knee patients received a DA. In phase 2, 54% (64/118) of spine referrals and 58% (189/324) of hip/knee referrals included a request to send a patient a DA. In phase 3, 56% (90/162) of spine patients and 69% (213/307) of hip/knee patients received a DA, significantly more than in phase 1 (P<0.0001). In phase 3, both more DAs were ordered by clinic staff compared with specialists (56% phase 3 vs 34% phase 1, P<0.001) and sent before the visit (74% phase 3 vs 17% phase 1, P<0.001). Patients were more likely to report reviewing the DA when delivered before the visit (63% before vs 50% after, P=0.005).

Conclusion: DA implementation into clinic workflow is possible and facilitated by engagement of the entire care team and the support of health information technology.

Keywords: implementation science; patient-centred care; quality improvement; shared decision-making; surgery.

Conflict of interest statement

Competing interests: KRS reports grants from the Gordon and Betty Moore Foundation during the conduct of the study; other from Informed Medical Decision Foundation, outside the submitted work. TDC reports grants from the Gordon and Betty Moore Foundation during the conduct of the study; grants from North American Spine Society, personal fees from Bio2, personal fees from GE Healthcare, personal fees from Nuvasive, and personal fees from K2M outside the submitted work. HER reports personal fees from Stryker, personal fees from Ceramtec, personal fees from Lippincott, Williams & Wilkins, personal fees from Flexion Therapeutics, personal fees from Pacira, non-financial support from Hip Society, other from Orthopaedic Technology Group, outside the submitted work.

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