Group Health Research Institute, USA.
Health Aff (Millwood). 2012 Sep;31(9):2094-104. doi: 10.1377/hlthaff.2011.0686.
Decision aids are evidence-based sources of health information that can help patients make informed treatment decisions. However, little is known about how decision aids affect health care use when they are implemented outside of randomized controlled clinical trials. We conducted an observational study to examine the associations between introducing decision aids for hip and knee osteoarthritis and rates of joint replacement surgery and costs in a large health system in Washington State. Consistent with prior randomized trials, our introduction of decision aids was associated with 26 percent fewer hip replacement surgeries, 38 percent fewer knee replacements, and 12-21 percent lower costs over six months. These findings support the concept that patient decision aids for some health conditions, for which treatment decisions are highly sensitive to both patients' and physicians' preferences, may reduce rates of elective surgery and lower costs.
决策辅助工具是基于证据的健康信息来源，可以帮助患者做出明智的治疗决策。然而，当决策辅助工具在随机对照临床试验之外实施时，它们如何影响医疗保健的使用情况却知之甚少。我们进行了一项观察性研究，以调查在华盛顿州的一个大型医疗系统中引入髋关节和膝关节骨关节炎决策辅助工具与关节置换手术率和成本之间的关联。与之前的随机试验一致，我们引入决策辅助工具与髋关节置换手术减少 26%、膝关节置换手术减少 38%以及六个月内成本降低 12-21%相关。这些发现支持这样一种观点，即对于某些健康状况，患者决策辅助工具对于那些治疗决策对患者和医生的偏好都高度敏感的情况，可能会降低选择性手术的比例并降低成本。
