After introducing video-based decision aids for people with knee and hip osteoarthritis, Group Health Cooperative saw a significant drop in rates of elective knee and hip replacement surgeries, as well as a drop in the cost of care. According to an article in the September issue of Health Affairs, Group Health found that introducing these decision aids resulted in a 38 percent reduction in knee replacement surgeries, a 26 percent reduction in hip replacement surgeries and a 12 percent decline in health care costs over a six month period.
This month, a much anticipated study was published in Health Affairs that addresses something we are often asked at the Informed Medical Decisions Foundation: What are the effects of decision aids on utilization rates and medical costs? Researchers from Group Health Cooperative found that when decisions aids were used for patients making a decision about whether or not to have elective knee or hip replacement surgeries, there was a significant drop in surgical procedures as more patients opted for more conservative, less costly treatment options.
Arterburn D, Wellman R, Westbrook E, et al. Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs. Health Aff. 2012 Sept 4;(9):2094-104.
The two decision tools, which were developed by the Informed Medical Decisions Foundation in Boston and Health Dialog, explain to patients details of the surgery they are about to have, what non-surgical options exist, what life-style changes they could make, and what physical therapy and walking aids or pain medications, or complementary and alternative therapies might be selected instead of surgery.
Dr. Richard Wexler, chief medical officer of the Informed Medical Decisions Foundation, Boston, contends that financial incentives will probably need to be much more explicitly tied to shared decisionmaking [sic], however, in order to effect real change. "It's very hard to get shelf space for this because physicians have so many competing opportunities to do good things related to improvement," Wexler said. "Unless we realign incentives to highlight shared decisionmaking [sic] and attach some real financial importance to it, I think we'll have trouble competing with the other things that are rewarded in our system."