Use of Osteoarthritis Decision Aids Led to More Hip, Knee Replacement Surgeries

Osteoarthritis patients who used decision aids were about twice as likely or more to have knee or hip replacement surgery within six months of discussing options with their physician, according to a study partially funded by AHRQ and published in Health Affairs. Researchers analyzed 2012–15 data for about 5,700 patients within the High Value Healthcare Collaborative, a learning network representing 10 health systems nationwide. The decision aids were video or Web-based tools used by patients and physicians to discuss tradeoffs and benefits of treatment options. While previous research from single-system trials has generally shown patients using decision aids tend to choose more conservative treatment options, the study’s authors suggested healthcare systems that use decision aids in hip and knee osteoarthritis consultations should not expect fewer surgeries. Access the abstract.

The Impact Of Decision Aids On Adults Considering Hip Or Knee Surgery

Vanessa B Hurley 1, Hector P Rodriguez 2, Stephen Kearing 3, Yue Wang 4, Ming D Leung 5, Stephen M Shortell 6

Affiliations

PMID: 31905066
DOI: 10.1377/hlthaff.2019.00100

Abstract

Trials of decision aids developed for use in shared decision making find that patients engaged in that process tend to choose more conservative treatment for preference-sensitive conditions. Shared decision making is a collaborative process in which clinicians and patients discuss trade-offs and benefits of specific treatment options in light of patients' values and preferences. Decision aids are paper, video, or web-based tools intended to help patients match personal preferences with available treatment options. We analyzed data for 2012-15 about patients within the ten High Value Healthcare Collaborative member systems who were exposed to condition-specific decision aids in the context of consultations for hip and knee osteoarthritis, with the intention that the aids be used to support shared decision making. Compared to matched patients not exposed to the decision aids, those exposed had two-and-a-half times the odds of undergoing hip replacement surgery and nearly twice the odds of undergoing knee replacement surgery within six months of the consultation. These findings suggest that health care systems adopting decision aids developed for use in shared decision making, and used in conjunction with hip and knee osteoarthritis consultations, should not expect reduced surgical utilization.

Keywords: Access and use; Comorbidity; Depression; Health policy; Hip osteoarthritis; Knee osteoarthritis; Medicaid; Medicaid patients; Patient engagement; Shared decision making; Surgery; Systems of care; Value.