3.3 Key Findings
Although the majority of knee patients (68.3%) and hip patients (71.9%) received treatment aligned with their post-decision aids choices, regression analyses reveal important differences in the odds of such alignment by patient characteristics. In final models (reported in Table 2), knee patients who were Medicare beneficiaries had 49% lower odds of receiving choice-aligned treatments after exposure to decision aids compared with privately insured patients (OR = 0.51, p<0.01, Confidence Interval (CI): 0.32-0.80), while knee patients who were Medicaid beneficiaries had 59% lower odds of receiving treatment aligned with their choices (OR = 0.41, p<0.01, CI: 0.22-0.76). A similar association was found among hip osteoarthritis patients who were Medicare beneficiaries, but this finding did not reach statistical significance (OR = 0.83, p>0.05, 95% CI: 0.41-1.68). Knee and hip patients who were dual eligible (Medicare and Medicaid) had 59% and 92% lower odds (respectively) of receiving treatments aligned with their choices relative to privately insured knee and hip patients (OR = 0.41, p<0.05, 95% CI: 0.19-1.38 and OR = 0.08, p<0.05, 95% CI: 0.01-0.80).
Black or African American patients with knee osteoarthritis had nearly 50% lower odds of receiving treatment reflective of their post-decision aid choices compared to white patients with knee osteoarthritis (OR = 0.48, p<0.05, 95% CI: 0.26-0.81). Hip patients with high pain scores had greater odds of receiving treatment aligned with their post-decision aid choices compared with patients reporting low pain scores (OR = 1.59, CI: 0.70-3.65). Although this finding did not achieve statistical significance (p =0.3), the magnitude of the odds ratio is noteworthy. Compared with patients at a more advanced decision-making stage after viewing decision aids, patients at an earlier stage (“close to a decision” versus “already decided” also had lower odds of receiving treatments aligned with their post-decision aid treatment choices (OR = 0.40, p<0.01, 95% CI: 0.28-0.58 for knee patients and OR = 0.75, p<0.05, 95% CI: 0.22-0.75 for hip patients).
In analyses that explore the association between patient-level characteristics with the odds of alignment between treatment choices and treatments among patients who chose surgery (reported in Table 3), Black or African American patients with knee osteoarthritis had 72% lower odds of such congruence compared with white patients (OR = 0.28, p<0.001, CI: 0.13-0.62). Medicare beneficiaries who chose knee surgery also had lower odds of alignment between their choice and treatment received relative to patients with private insurance (OR = 0.36, p<0.001, CI: 0.20-0.64). Patients with knee osteoarthritis who chose surgery but were still considering their options (OR = 0.28, p<0.001, CI: 0.15-0.51) or close to a decision (OR = 0.31, p<0.001, CI: 0.20-0.48) had lower odds of alignment between their choice and treatment received compared with knee patients who reported having already decided upon surgery. Among patients with hip osteoarthritis who chose surgery, those who were still considering their options and those close to a decision also had lower odds of alignment between their choices and treatments received (OR = 0.44, p<0.05, CI: 0.20-0.99 and OR = 0.42, p<0.05, CI: 0.21-0.83, respectively) compared with patients who reported having decided upon surgery.