Shared Decision Making Video
December 13, 2012 at 9:19 am
After widespread implementation of the videos, known as “decision aids,” for patients with knee and hip arthritis at Group Health the rate of knee replacements plunged 38 percent, while hip replacements dropped 26 percent. The cost of caring for those patients also declined by 12 and 21 percent respectively over six months, according the study in the September issue of the Health Affairs journal.
The study has big implications, because of the vast numbers of joint replacements performed annually. More than 27 million Americans suffer from arthritis, which can cause severe pain and restrict functioning, including employment. Joint replacement is among the most common U.S. orthopedic procedures, with more than 650,000 knees and 250,000 hips replaced each year, at a combined cost of $15.6 billion.
“Decision aids are balanced sources of information that clearly present the evidence-based pros and cons of treatment options for a health condition,” said study leader David E. Arterburn, MD, MPH, a general internist and associate investigator at the Group Health Research Institute. Group Health has distributed more decision aids than any other single health care organization in the world.
Dr. Arterburn and colleagues studied 9,515 patients with knee or hip arthritis who watched the decision aids and their subsequent choices about joint replacement surgery. It’s the first study to investigate how the use of these decision aids in routine clinical practice can affect care and costs, and it is the first major study of their use in knee and hip arthritis.
“Treatment decisions for some health conditions are highly sensitive to the preferences of patients and doctors,” said Dr. Arterburn, who also is an affiliate professor at the University of Washington in Seattle. “When patients have access to objective, easy-to-understand, evidenced-based information about the risks and benefits of a given treatment, they’re more likely to make informed choices that align with their preferences. In our experience, implementing decision aids often means less elective surgery and can also mean lower costs.”
The study’s findings are consistent with results of prior randomized trials of other kinds of decision aids. Those trials found that people who had access to decision aids tended to choose more conservative, less invasive options.