Hurley Vanessa B, Wang Yue, Rodriguez Hector P, Shortell Stephen M, Kearing Stephen, Savitz Lucy A
Health Systems Administration, Georgetown University, Washington, DC 20057, USA.
Tile, San Mateo, CA 94403, USA.
Patient Prefer Adherence. 2020 Jan 6;14:23-32. doi: 10.2147/PPA.S227207. eCollection 2020.
Shared decision making (SDM) research has emphasized the role of decision aids (DAs) for helping patients make treatment decisions reflective of their preferences, yet there have been few collaborative multi-institutional efforts to integrate DAs in orthopedic consultations and primary care encounters.
In the context of routine DA implementation for SDM, we investigate which patient-level characteristics are associated with patient preferences for surgery versus medical management before and after exposure to DAs. We explored whether DA implementation in primary care encounters was associated with greater shifts in patients' treatment preferences after exposure to DAs compared to DA implementation in orthopedic consultations.
Retrospective cohort study.
10 High Value Healthcare Collaborative (HVHC) health systems.
A total of 495 hip and 1343 adult knee osteoarthritis patients who were exposed to DAs within HVHC systems between July 2012 to June 2015.
Nearly 20% of knee patients and 17% of hip patients remained uncertain about their treatment preferences after viewing DAs. Older patients and patients with high pain levels had an increased preference for surgery. Older patients receiving DAs from three HVHC systems that transitioned DA implementation from orthopedics into primary care had lower odds of preferring surgery after DA exposure compared to older patients in seven HVHC systems that only implemented DAs for orthopedic consultations.
Patients' treatment preferences were largely stable over time, highlighting that DAs for SDM largely do not necessarily shift preferences. DAs and SDM processes should be targeted at older adults and patients reporting high pain levels. Initiating treatment conversations in primary versus specialty care settings may also have important implications for engagement of patients in SDM via DAs.
共同决策（SDM）研究强调了决策辅助工具（DAs）在帮助患者做出符合其偏好的治疗决策方面的作用，但很少有合作性的多机构努力将决策辅助工具整合到骨科会诊和初级保健诊疗中。
在将决策辅助工具常规应用于共同决策的背景下，我们调查在接触决策辅助工具前后，哪些患者层面的特征与患者对手术与药物治疗的偏好相关。我们探讨了在初级保健诊疗中应用决策辅助工具与在骨科会诊中应用决策辅助工具相比，在接触决策辅助工具后患者的治疗偏好是否有更大的转变。
回顾性队列研究。
10个高价值医疗协作（HVHC）卫生系统。
2012年7月至2015年6月期间在HVHC系统中接触过决策辅助工具的495名髋部和1343名成人膝骨关节炎患者。
近20%的膝部患者和17%的髋部患者在查看决策辅助工具后仍对其治疗偏好不确定。老年患者和疼痛程度高的患者对手术的偏好增加。与仅在七个HVHC系统中为骨科会诊实施决策辅助工具的老年患者相比，在三个将决策辅助工具实施从骨科转变为初级保健的HVHC系统中接受决策辅助工具的老年患者在接触决策辅助工具后选择手术的几率较低。
患者的治疗偏好在很大程度上随时间保持稳定，这突出表明用于共同决策的决策辅助工具不一定会改变偏好。决策辅助工具和共同决策过程应针对老年人和报告疼痛程度高的患者。在初级保健与专科护理环境中启动治疗对话也可能对通过决策辅助工具让患者参与共同决策产生重要影响。
