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.