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

doi:10.2147/PPA.S227207

. 2020 Jan 6:14:23-32.

doi: 10.2147/PPA.S227207. eCollection 2020.

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

Vanessa B Hurley¹, Yue Wang², Hector P Rodriguez³, Stephen M Shortell³, Stephen Kearing⁴, Lucy A Savitz⁵

Affiliations

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

PMID: 32021114
PMCID: PMC6954078
DOI: 10.2147/PPA.S227207

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

Vanessa B Hurley et al. Patient Prefer Adherence. 2020.

. 2020 Jan 6:14:23-32.

doi: 10.2147/PPA.S227207. eCollection 2020.

Authors

Vanessa B Hurley¹, Yue Wang², Hector P Rodriguez³, Stephen M Shortell³, Stephen Kearing⁴, Lucy A Savitz⁵

Affiliations

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

PMID: 32021114
PMCID: PMC6954078
DOI: 10.2147/PPA.S227207

Abstract

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: collaborative learning; health systems; patient engagement; patient preferences; quality of care; shared decision making.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

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[1] Elwyn G, Edwards A, Kinnersley P. Shared decision making in primary care: the neglected second half of the consultation. Br J Gen Pract. 1999;49(443):477–482. - PMC - PubMed

[2] Elwyn G, Edwards A, Kinnersley P. Shared decision making in primary care: the neglected second half of the consultation. Br J Gen Pract. 1999;49(443):477–482. - PMC - PubMed

[3] Gionfriddo MR, Leppin AL, Brito JP, LeBlanc A, Boehmer KR. A systematic review of shared decision making interventions in chronic conditions: a review protocol. Syst Rev. 2014;3:38. doi:10.1186/2046-4053-3-38 - DOI - PMC - PubMed

[4] Gionfriddo MR, Leppin AL, Brito JP, LeBlanc A, Boehmer KR. A systematic review of shared decision making interventions in chronic conditions: a review protocol. Syst Rev. 2014;3:38. doi:10.1186/2046-4053-3-38 - DOI - PMC - PubMed

[5] Stacey D, Bennett CL, Barry MJ. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011;10. - PubMed

[6] Stacey D, Bennett CL, Barry MJ. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011;10. - PubMed

[7] Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decision Making. 2015;35(1):114–131. doi:10.1177/0272989X14551638 - DOI - PMC - PubMed

[8] Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decision Making. 2015;35(1):114–131. doi:10.1177/0272989X14551638 - DOI - PMC - PubMed

[9] Lin GA, Halley M, Rendle KA, Tietbohl C. An effort to spread decision aids in five California primary care practices yielded low distribution, highlighting hurdles. Health Aff. 2013;32(2):311–320. doi:10.1377/hlthaff.2012.1070 - DOI - PubMed

[10] Lin GA, Halley M, Rendle KA, Tietbohl C. An effort to spread decision aids in five California primary care practices yielded low distribution, highlighting hurdles. Health Aff. 2013;32(2):311–320. doi:10.1377/hlthaff.2012.1070 - DOI - PubMed

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

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

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