Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study

BMC Musculoskeletal Disorders

Terence Doorly¹  James Kang²  Antonia F. Chen²  Todd O’Brien²  Thomas Sequist²  Adam Licurse²  John C. Giardina³  Hany Bedair⁴  Tom Cha⁴  Felisha Marques⁴  Lauren Leavitt⁴  Karen Sepucha⁴  K. D. Valentine⁴  Steven J. Atlas⁴ 

[1] Brigham and Women’s Hospital (BWH);Harvard Medical School (HMS);Harvard T.H. Chan School of Public Health;Massachusetts General Hospital (MGH);

关键词: Shared decision making;    Quality measurement;    Osteoarthritis;    Total joint replacement;    Spine surgery;   

DOI  :  10.1186/s12891-021-04853-x

来源: DOAJ

【 摘 要 】

Abstract Background Clinical guidelines recommend engaging patients in shared decision making for common orthopedic procedures; however, limited work has assessed what is occurring in practice. This study assessed the quality of shared decision making for elective hip and knee replacement and spine surgery at four network-affiliated hospitals. Methods A cross-sectional sample of 875 adult patients undergoing total hip or knee joint replacement (TJR) for osteoarthritis or spine surgery for lumbar herniated disc or lumbar spinal stenosis was selected. Patients were mailed a survey including measures of Shared Decision Making (SDMP scale) and Informed, Patient-Centered (IPC) decisions. We examined decision-making across sites, surgeons, and conditions, and whether the decision-making measures were associated with better health outcomes. Analyses were adjusted for clustering of patients within surgeons. Results Six hundred forty-six surveys (74% response rate) were returned with sufficient responses for analysis. Patients who had TJR reported lower SDMP scores than patients who had spine surgery (2.2 vs. 2.8; p < 0.001). Patients who had TJR were more likely to make IPC decisions (OA = 70%, Spine = 41%; p < 0.001). SDMP and IPC scores varied widely across surgeons, but the site was not predictive of SDMP scores or IPC decisions (all p > 0.09). Higher SDMP scores and IPC decisions were associated with larger improvements in global health outcomes for patients who had TJR, but not patients who had spine surgery. Conclusions Measures of shared decision making and decision quality varied among patients undergoing common elective orthopedic procedures. Routine measurement of shared decision making provides insight into areas of strength across these different orthopedic conditions as well as areas in need of improvement.

【 授权许可】

Unknown