Are patients really getting what they want? The routine implementation of decision aids for patients with hip or knee osteoarthritis in the high value healthcare collaborative and alignment between patient treatment choice and receipt

Abstract

Rationale, Aims and Objectives Alignment between patients' treatment choices and treatments received is acknowledged as an important outcome of shared decision‐making (SDM), yet recent research suggests that patients' choices do not always align with their actual treatment trajectories. This paper explores the alignment of patient‐expressed treatment choices (for surgery or medical management) after exposure to decision aids and treatments received among patients with hip or knee osteoarthritis within High Value Healthcare Collaborative (HVHC) systems as the collaborative integrated decision aids intended to support SDM into routine clinical practice. Method This retrospective cohort study examines data from adult (≥18 years) patients with hip or knee osteoarthritis who received decision aids as part of orthopaedic consultations within HVHC systems between 2012 and 2015. Multivariable logistic regression explored the association between patient‐level characteristics with the odds of treatment choice‐receipt alignment. Results The majority of patients with knee osteoarthritis (68.3%) and hip osteoarthritis (71.9%) received treatments aligned with their choices following exposure to decision aids, but analyses reveal important differences in the odds of such alignment across patient characteristics. In adjusted models, African American patients with knee osteoarthritis had 50% lower odds of receiving treatment aligned with their choices compared with Caucasian patients (OR = 0.52, P < .05). Medicare‐ or Medicaid‐insured knee patients had 49% and 59% lower odds (respectively) of receiving choice‐aligned treatments relative to privately insured patients. Patients with knee (OR = 0.40, P < .01) or hip (OR = 0.75, P < .05) osteoarthritis at earlier decision‐making stages had lower odds of receiving treatments congruent with their choices. Conclusion This work elucidates the odds of treatment choice‐aligned care for patients within health care systems attempting to routinely integrate decision aids to support SDM into clinical practice and underscores the gaps in achieving this alignment among African American patients, those with public insurance and those at early decision‐making stages.

Evaluating a web‐based personalized decision report for total knee or hip replacement: Lessons learned from patients

“…Although the overall report content was satisfactory for most participants, individuals attributed differential value to data elements and their presentation, which was often associated with stage of disease or decision regarding surgery. Similarly, varying benefits across the decision‐making continuum have been reported for non‐personalized hip/knee OA decision reports 31 . Additionally, trial surgeons in our study also reported differential use and value of different report sections 32 .…”

“…Similarly, varying benefits across the decision-making continuum have been reported for nonpersonalized hip/knee OA decision reports. 31 Additionally, trial surgeons in our study also reported differential use and value of different report sections. 32 Our combined findings across patients and surgeons suggest that further tailoring could maximize broader report acceptability and perceived relevance.…”

Development of a personalized shared decision-making tool for knee osteoarthritis and user-testing with African American and Latina women

“…This calculation is valid only for large populations and is intended to promote discussion with the patient about comparative lost productivity, with the most important point being that productivity loss is highest when the patient “does nothing.” The SDM tool relies on multiple data sources, including the Hospital Cost and Utilization Project, the Behavioral Risk Factor Surveillance System, Truven Health MarketScan Research Databases, the Medicare Expenditure Panel Survey, the National Vital Statistics Report, treatment guidelines from the American Academy of Orthopaedic Surgeons, and treatment effects extracted from systematic literature reviews, meta-analyses of randomized, controlled trials, and published randomized controlled trials,[ 19 ] as well as patient and health care provider focus groups. [ 20 ]…”

“…Recognizing the urgent need to address musculoskeletal health disparities, Movement is Life, a multidisciplinary consortium comprising racially and ethnically diverse individuals,[ 16 17 ] created an innovative SDM tool to facilitate discussions between clinicians and patients regarding treatment options for chronic knee pain. As disparities in the treatment of osteoarthritis in diverse populations have been reported,[ 19 ] and these patients may have lower odds of receiving treatment aligned with their choices,[ 20 ] the user-testing specifically recruited African American and Latina women. Primary care providers and family physicians are often the first healthcare providers to become aware of a patient’s symptoms associated with early stage osteoarthritis.…”

“…This tool provides a framework for a clear, concise, and patient-specific treatment discussion to help the physician communicate options effectively. The treatment is then more likely to align with the patient’s treatment preferences[ 20 ] and result in better compliance.…”