Health Systems Administration, Georgetown University, Washington, District of Columbia, USA.
J Eval Clin Pract. 2021 Dec;27(6):1207-1215. doi: 10.1111/jep.13570. Epub 2021 Apr 7.
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 integrated decision aids intended to support SDM into routine clinical practice.
This retrospective cohort study examines data from adult (≥18 years) patients with hip or knee osteoarthritis who received decision aids as part of orthopaedic consultations within HVHC systems between 2012 and 2015. Multivariable logistic regression explored the association between patient-level characteristics with the odds of treatment choice-receipt alignment.
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 Caucasian patients (OR = 0.52, P < .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 < .01) or hip (OR = 0.75, P < .05) osteoarthritis at earlier decision-making stages had lower odds of receiving treatments congruent with their choices.
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.
背景、目的和目标：患者的治疗选择与实际治疗之间的一致性被认为是共同决策（SDM）的一个重要结果，但最近的研究表明，患者的选择并不总是与他们的实际治疗轨迹一致。本文探讨了在高价值医疗保健协作（HVHC）系统中，接受髋关节或膝关节骨关节炎治疗的患者在接受决策辅助工具后表达的治疗选择（手术或药物治疗）与实际接受的治疗之间的一致性，因为协作式综合决策辅助工具旨在将 SDM 纳入常规临床实践。
本回顾性队列研究分析了 2012 年至 2015 年期间，在 HVHC 系统中接受过骨科咨询的髋关节或膝关节骨关节炎成年（≥18 岁）患者的数据。多变量逻辑回归探讨了患者特征与治疗选择与实际治疗一致的可能性之间的关联。
大多数膝关节骨关节炎（68.3%）和髋关节骨关节炎（71.9%）患者在接受决策辅助工具后接受了与选择一致的治疗，但分析显示，在患者特征方面，这种一致性的可能性存在显著差异。在调整后的模型中，与白人患者相比，膝关节骨关节炎的非裔美国患者接受与选择一致的治疗的可能性低 50%（OR=0.52，P<0.05）。医疗保险或医疗补助患者接受与选择一致的治疗的可能性分别比私人保险患者低 49%和 59%。在决策早期阶段患有膝关节（OR=0.40，P<0.01）或髋关节（OR=0.75，P<0.05）骨关节炎的患者，接受与选择一致的治疗的可能性较低。
这项工作阐明了在试图将决策辅助工具常规纳入支持 SDM 的临床实践的医疗保健系统中，患者接受与治疗选择一致的治疗的可能性，并强调了在非裔美国患者、公共保险患者和决策早期阶段患者中实现这种一致性方面的差距。
