Health Dialog, a provider of integrated population health management solutions for health plans, risk-bearing providers and self-insured employers, announced that the Washington State Health Care Authority has certified its decision aids for hip and knee surgery.
Washington State Oks Advanced Patient Decision Tools

Decision aids are tools that facilitate shared decision making (SDM). SDM helps patients choose evidence-based and often less invasive care, achieve better health outcomes and be happier with both their care and their provider by engaging them in their treatment choice.
A study conducted by Group Health and published in Health Affairs analyzed results from the use of Health Dialog’s hip and knee decision aids. The study showed that knee replacement surgeries declined by 38% after 18 months and hip replacement surgeries declined by 26% after 18 months. Costs declined by 12% to 21% after six months.
The decision aids help patients who are considering joint replacement surgery for hip or knee osteoarthritis make more informed decisions about surgery that reflect their lifestyle and values. Studies show Health Dialog’s decision aids for hip and knee replacement surgeries were associated with significant declines in elective surgery and attendant costs.
Peter Goldbach, M.D. chief medical officer for Health Dialog said, “The State of Washington has shown true leadership in promoting shared decision making, a practice that has helped engage patients in their care, improve patient satisfaction and health outcomes and reduce wasteful medical costs. Washington’s most recent review process, which certified just four decision aids, will help to expand the benefits of this important practice to people in Washington and across the country. We’re pleased that our aids were among those certified.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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