Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation

BMC Musculoskeletal Disorders

Carrie A Levin^1,13  Peter Tugwell^1,10  Ivan Tomek^1,14  Monica Taljaard^1,11  Henrik Malchau⁶  Stephen A Kearing⁷  Jeffrey N Katz^1,15  Sandra Feibelmann⁸  Janet Dorrwachter⁵  Geoffrey Dervin³  Carol Cosenza^1,12  Yuchiao Chang¹  Catharine F Clay⁴  Dawn Stacey⁹  Karen R Sepucha² 

[1] General Medicine Division, MGH, HMS, Boston, MA, USA;General Medicine Division, Massachusetts General Hospital (MGH), Harvard Medical School (HMS), Boston, MA, USA;Division of Orthopaedic Surgery, The Ottawa Hospital and U of O, Ottawa, Canada;Center for Shared Decision Making, Dartmouth-Hitchcock Medical Center, Lebanon NH USA;Department of Orthopedic Surgery, MGH Boston MA, USA;Department of Orthopedic Surgery, MGH, HMS, Boston, MA, USA;The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School (DMS), Lebanon, NH, USA;General Medicine Division, MGH Boston MA, USA;Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI) and Faculty of Health Sciences, University of Ottawa (U of O), Ottawa, Canada;Department of Medicine, Ottawa Hospital; Senior Scientist, OHRI, Ottawa, Canada;Clinical Epidemiology Program, OHRI and Department of Epidemiology and Community Medicine, U of O, Ottawa, Canada;Center for Survey Research, University of Massachusetts Boston, MA USA;Foundation for Informed Medical Decision Making, Boston, MA USA;Department of Orthopedic Surgery, DMS, Lebanon, NH USA;Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, HMS, Boston, MA USA

关键词: decision quality;    total joint replacement;    osteoarthritis;    quality measurement;    patient centered care;    shared decision making;   

Others  :  1152821
DOI  :  10.1186/1471-2474-12-149

 received in 2011-03-07, accepted in 2011-07-05,  发布年份 2011

【 摘 要 】

Background

A high quality decision requires that patients who meet clinical criteria for surgery are informed about the options (including non-surgical alternatives) and receive treatments that match their goals. The aim of this study was to evaluate the psychometric properties and clinical sensibility of a patient self report instrument, to measure the quality of decisions about total joint replacement for knee or hip osteoarthritis.

Methods

The performance of the Hip/Knee Osteoarthritis Decision Quality Instrument (HK-DQI) was evaluated in two samples: (1) a cross-sectional mail survey with 489 patients and 77 providers (study 1); and (2) a randomized controlled trial of a patient decision aid with 138 osteoarthritis patients considering total joint replacement (study 2). The HK-DQI results in two scores. Knowledge items are summed to create a total knowledge score, and a set of goals and concerns are used in a logistic regression model to develop a concordance score. The concordance score measures the proportion of patients whose treatment matched their goals. Hypotheses related to acceptability, feasibility, reliability and validity of the knowledge and concordance scores were examined.

Results

In study 1, the HK-DQI was completed by 382 patients (79%) and 45 providers (58%), and in study 2 by 127 patients (92%), with low rates of missing data. The DQI-knowledge score was reproducible (ICC = 0.81) and demonstrated discriminant validity (68% decision aid vs. 54% control, and 78% providers vs. 61% patients) and content validity. The concordance score demonstrated predictive validity, as patients whose treatments were concordant with their goals had more confidence and less regret with their decision compared to those who did not.

Conclusions

The HK-DQI is feasible and acceptable to patients. It can be used to assess whether patients with osteoarthritis are making informed decisions about surgery that are concordant with their goals.

【 授权许可】

   
2011 Sepucha et al; licensee BioMed Central Ltd.

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