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

BMC Musculoskeletal Disorders

Research Article

Catharine F Clay¹  Carol Cosenza²  Monica Taljaard³  Dawn Stacey⁴  Peter Tugwell⁵  Jeffrey N Katz⁶  Ivan Tomek⁷  Janet Dorrwachter⁸  Henrik Malchau⁹  Geoffrey Dervin^1,10  Carrie A Levin^1,11  Sandra Feibelmann^1,12  Yuchiao Chang^1,13  Karen R Sepucha^1,14  Stephen A Kearing^1,15 

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

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

DOI  :  10.1186/1471-2474-12-149

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

来源: Springer

【 摘 要 】

BackgroundA 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.MethodsThe 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.ResultsIn 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.ConclusionsThe 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】

CC BY   
© Sepucha et al; licensee BioMed Central Ltd. 2011