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247 Orthopaedic shared decision making learning collaborative reaches 10,000 patients with decision aids
  1. Karen Sepucha1,2,
  2. Ha Vo1,
  3. Felisha Marques1,
  4. KD Valentine1,2,
  5. Thomas Cha4,
  6. Antonia Chen5,
  7. Ayesha Abdeen6,
  8. Jesse Eisler7,
  9. David Freccero4,
  10. Prakash Jayakumar7,
  11. Jesse Eisler8,
  12. Kathleen Paul9,
  13. Benjamin Ricciardi10,
  14. Daniel Vigil11,12,
  15. Emily Kropfl8,
  16. Theresa Williamson13,
  17. Adolph Yates8
  1. 1Harvard Medical School, Boston, MA, USA
  2. 2Health Decision Sciences Center, Massachusetts General Hospital, Boston, MA, USA
  3. 3Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
  4. 4Department of Orthopaedics, Brigham and Women’s Hospital, Boston, MA, USA
  5. 5Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
  6. 6Bone and Joint Institute, Hartford Healthcare, Hartford, CT, USA
  7. 7The Musculoskeletal Institute, The University of Texas at Austin, Dell Medical School, Austin, TX, USA
  8. 8Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  9. 9Kaiser Permanente Washington, Seattle, WA, USA
  10. 10Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, NY, USA
  11. 11Department of Orthopaedic Surgery, Divisions of Primary Care Sports Medicine (Chief), Los Angeles, CA, USA
  12. 13Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA

Abstract

Purpose To promote implementation of decision aids (DAs) for patients considering hip, knee, and spine surgery.

Methods A Learning Collaborative (LC) was conducted in the United States over 15-months. The coordinating center hosted one in-person and four virtual sessions and held 1–1 monthly check-in calls with sites. Seventeen practices within thirteen sites participated. Average annual surgical volume was 507 cases and over half of practices (65%, 11/17) had prior experience with orthopaedic DAs. Clinicians and staff completed a survey at baseline. During the LC, sites provided monthly data on DAs. We examined the number of DAs delivered and percent of patients reached. We explored predictors of reach (e.g. prior DA experience, surgical volume). We calculated descriptive statistics and explored relationships with predictors using correlations, t-tests, or ANOVA, as appropriate.

Results Over the 15-months of the LC, sites distributed a total of 10,009 DAs and reached an average of 41% of eligible patients (range 0%-94% by practice). Patients receiving DAs were on average 65 years old, female (51%), White (58%), and 6% were Hispanic. Sites who indicated at baseline that DA delivery was a high priority for clinical staff had higher reach (65% reach for high priority vs 46% for moderate priority vs 8% for low priority, p=0.07, Omega=0.22). Surgical volume was strongly correlated with the number of DAs delivered (r=0.88, p<0.001), but not with reach (r=0.19, p=0.49). One unexpected finding was that sites with no prior experience with DAs had higher reach than those with prior experience (52% vs 36%, p=0.31, d=0.53).

Discussion and Conclusion All sites were able to deliver DAs, reaching about 40% of eligible patients. Establishing DA delivery as a priority for staff at the outset was important for reach, while prior experience was not.

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