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
Vanessa B. Hurley, PhD, MPH, MS
St. Mary’s Hall 231, Georgetown University
3700 Reservoir Rd. NW
Washington, DC 20057
(202) 687-4209
vh151@georgetown.edu
Data Availability Statement: The datasets analyzed during the current study are not publicly available because they are restricted by the terms of the HVHC Master Collaboration Agreement.
Conflict of Interest: The author has no conflicts of interest to report.
Funding: The work described herein was funded [in part] by Members of the High Value Healthcare Collaborative (HVHC), a consortium of healthcare delivery systems sharing data and experiences to improve quality, outcomes, and cost of care. The views expressed are those of the authors and not necessarily those of all the participating HVHC Members.
Ethical Approval: This retrospective, de-identified analysis of data collected by the High Value Healthcare Collaborative was exempt from IRB review.
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 integrating 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 orthopedic consultations within HVHC systems between 2012-2015. Multivariate 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 white patients (OR = 0.52, p<0.05). 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<0.01) or hip (OR = 0.75, p<0.05) 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.
Keywords: patient-centered care, decision aids, treatment choices, learning collaborative