David Arterburn, M.D., M.P.H., Robert Wellman, M.S., Emily Westbrook, Carolyn Rutter, Ph.D., Tyler Ross, M.A., David McCulloch, M.D., Matthew Handley, M.D., and Charles Jung, M.D.
D. Arterburn, R. Wellman, E. Westbrook et al., "Introducing Decision Aids at Group Health Was Linked to Sharply Lower Hip and Knee Surgery Rates and Costs," Health Affairs, Sept. 2012 31(9):2094–104.
Decision aids may help patients with knee and hip osteoarthritis make more informed, cost-effective treatment choices. In a large observational study, patients who received balanced information on the risks and benefits of orthopedic procedures had 26 percent fewer hip replacement surgeries, 38 percent fewer knee replacement surgeries, and 12 percent to 21 percent lower costs over a six-month period.
Total hip and knee replacements are among the most common orthopedic procedures performed and cost an estimated $15.6 billion annually. Because the decision to perform surgery often comes down to preferences, it is important that both patients and doctors have evidence-based information about the risks and benefits of the procedures. Decision aids that present balanced information about treatment options have been shown to increase patients' knowledge and improve participation in care choices, but less is known about whether these aids influence surgical rates or costs of care. A Commonwealth Fund–supported study measured decision aids' influence on care and identified the characteristics of patients who chose surgery and the factors that influenced treatment costs.
While the study establishes that decision aids may be useful in improving decision quality and patient education for patients with hip and knee osteoarthritis, more research is needed to determine whether these aids would have an impact on the treatment of other preference-sensitive health conditions, such as abnormal uterine bleeding, uterine fibroids, lumbar herniated disc, lumbar spinal stenosis, chronic stable angina, benign prostatic hyperplasia, early-stage prostate cancer, and early-stage breast cancer.
The authors reported on changes in surgical rates and costs over six months following the start of a program to introduce decision aids for hip and knee osteoarthritis. The program was put in place by all orthopedic providers at Group Health, a health system covering more than 660,000 residents of Washington and Idaho. The study population included patients age 45 or older who were seen by an orthopedic provider over an 18-month period from January 2009 through mid-July 2010. Patients seen from January 2007 through July 2008 served as a control group. The decision aids were distributed to patients primarily in DVD and booklet format. Patients could also view the decision aids online.
The use of decision aids may reduce rates of elective surgery and lower costs, particularly when they are used for conditions in which treatment decisions are highly sensitive to both patients’ and physicians' preferences.