title: Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs.
abstract: Decision aids are evidence-based sources of health information that can help patients make informed treatment decisions. However, little is known about how decision aids affect health care use when they are implemented outside of randomized controlled clinical trials. We conducted an observational study to examine the associations between introducing decision aids for hip and knee osteoarthritis and rates of joint replacement surgery and costs in a large health system in Washington State. Consistent with prior randomized trials, our introduction of decision aids was associated with 26 percent fewer hip replacement surgeries, 38 percent fewer knee replacements, and 12-21 percent lower costs over six months. These findings support the concept that patient decision aids for some health conditions, for which treatment decisions are highly sensitive to both patients' and physicians' preferences, may reduce rates of elective surgery and lower costs.
authors.affiliation: Group Health Research Institute, USA. arterburn.d@ghc.org
authors.forename: David
authors.initials: D
authors.lastname: Arterburn
authors.forename: Robert
authors.initials: R
authors.lastname: Wellman
authors.forename: Emily
authors.initials: E
authors.lastname: Westbrook
authors.forename: Carolyn
authors.initials: C
authors.lastname: Rutter
authors.forename: Tyler
authors.initials: T
authors.lastname: Ross
authors.forename: David
authors.initials: D
authors.lastname: McCulloch
authors.forename: Matthew
authors.initials: M
authors.lastname: Handley
authors.forename: Charles
authors.initials: C
authors.lastname: Jung
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000706:statistics & numerical data*; D003363:Cost Control / Q000379:methods; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D036301:Qualitative Research; D014861:Washington