Shared decision making lowers elective surgery rates, costs

With healthcare reforms driving the industry toward shared decision making between patients and physicians, hospitals light want to look to Group Health, an integrated system in Seattle that saw significant drops in elective surgery rates and costs by distributing decision aids and engaging in conversations with patients about a course of action, according to an Agency for Healthcare Research and Quality (AHRQ) report.

Providers in five orthopedic clinics used video-based decision aids with 41 percent of eligible patients with hip osteoarthritis and 28 percent with knee osteoarthritis. During the two-year implementation period, overall hip replacement surgery rates at the 5 clinics dropped 26 percent compared to the rates of similar patients during two years before implementation, while knee replacement surgery rates fell by 38 percent.

Thanks in part to fewer hospitalizations, inpatient days and prescriptions, the adjusted average total costs for patients with hip osteoarthritis dropped 21 percent during 180 days after implementation and knee osteoarthritis patient costs dropped 12 percent.

Key to the program's success was support from senior leaders and clinic leaders who considered routine use of decision aids mandatory. Group Health also recognized the difficulty in using decision aids in life-threatening, time-sensitive cases and therefore focused the program on elective joint replacement surgery, the AHRQ report noted.

The shared decision making program also benefited from friendly competition among service line leaders, clinic leaders and individual providers, as monthly feedback showed their performance versus peers.

However, implementing shared decision making isn't as easy as it sounds, according to a February study by the RAND Corporation and Informed Medical Decisions Foundation. The study cited time-pressed physicians, lack of training about shared decision making and inadequate IT systems as major barriers, FierceHealthIT previously reported.

For more:
- here's the AHRQ report

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