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

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...

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Autores principales:	K. D. Valentine, Tom Cha, John C. Giardina, Felisha Marques, Steven J. Atlas, Hany Bedair, Antonia F. Chen, Terence Doorly, James Kang, Lauren Leavitt, Adam Licurse, Todd O’Brien, Thomas Sequist, Karen Sepucha
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Shared decision making Quality measurement Osteoarthritis Total joint replacement Spine surgery Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/be3726bda43d420f9358d36ea0967ac4
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spelling	oai:doaj.org-article:be3726bda43d420f9358d36ea0967ac42021-11-21T12:27:51ZAssessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study10.1186/s12891-021-04853-x1471-2474https://doaj.org/article/be3726bda43d420f9358d36ea0967ac42021-11-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04853-xhttps://doaj.org/toc/1471-2474Abstract 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.K. D. ValentineTom ChaJohn C. GiardinaFelisha MarquesSteven J. AtlasHany BedairAntonia F. ChenTerence DoorlyJames KangLauren LeavittAdam LicurseTodd O’BrienThomas SequistKaren SepuchaBMCarticleShared decision makingQuality measurementOsteoarthritisTotal joint replacementSpine surgeryDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Shared decision making Quality measurement Osteoarthritis Total joint replacement Spine surgery Diseases of the musculoskeletal system RC925-935
spellingShingle	Shared decision making Quality measurement Osteoarthritis Total joint replacement Spine surgery Diseases of the musculoskeletal system RC925-935 K. D. Valentine Tom Cha John C. Giardina Felisha Marques Steven J. Atlas Hany Bedair Antonia F. Chen Terence Doorly James Kang Lauren Leavitt Adam Licurse Todd O’Brien Thomas Sequist Karen Sepucha Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study
description	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.
format	article
author	K. D. Valentine Tom Cha John C. Giardina Felisha Marques Steven J. Atlas Hany Bedair Antonia F. Chen Terence Doorly James Kang Lauren Leavitt Adam Licurse Todd O’Brien Thomas Sequist Karen Sepucha
author_facet	K. D. Valentine Tom Cha John C. Giardina Felisha Marques Steven J. Atlas Hany Bedair Antonia F. Chen Terence Doorly James Kang Lauren Leavitt Adam Licurse Todd O’Brien Thomas Sequist Karen Sepucha
author_sort	K. D. Valentine
title	Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study
title_short	Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study
title_full	Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study
title_fullStr	Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study
title_full_unstemmed	Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study
title_sort	assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/be3726bda43d420f9358d36ea0967ac4
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Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study

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