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.
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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.
A sleeper provision of the Affordable Care Act (ACA) encourages greater use of shared decision making in health care. For many health situations in which there's not one clearly superior course of treatment, shared decision making can ensure that medical care better aligns with patients' preferences and values. One way to implement this approach is by using patient decision aids -- written materials, videos, or interactive electronic presentations designed to inform patients and their families about care options; each option's outcomes, including benefits and possible side effects; the health care team's skills; and costs. Shared decision making has the potential to provide numerous benefits for patients, clinicians, and the health care system, including increased patient knowledge, less anxiety over the care process, improved health outcomes, reductions in unwarranted variation in care and costs, and great alignment of care with patients' values.
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An observational study reporting the changes in surgical rates and costs in the first eighteen months following the start of a program to introduce decision aids for hip and knee osteoarthritis in the Group Health system. They found a 38% reduction in knee surgeries and a 26% reduction in hip surgeries; findings consistent with results from randomized studies of decision aids.
Dr. David Arterburn, lead author of the Health Affairs study and a researcher at Group Health Research Institute in Seattle, calls the procedure "preference-sensitive" because the choice to have one isn't made solely on objective measures. That's where decision aids come in. The goal, he said, is 'to make sure that patients understand that there is more than one option when it comes to osteoarthritis treatment.
The decision aids referenced in this article were developed by the Informed Medical Decisions Foundation.
Read the full-text article.
Tagged arthritis, David Arterburn, decision aids, Group Health, Health Affairs, health care cost, hip osteoarthritis, informed decisions, knee osteoarthritis, surgery, The Boston Globe