Patients Who Feel Involved Have Better Outcomes?

Joint research between the Dartmouth Medical School in Hanover, New Hampshire and the HealthPartners Institute in Minneapolis, Minnesota suggests don’t underestimate the power of patient involvement.

This team has just published a study titled, “Is Shared Decision-making Associated with Better Patient-reported Outcomes? A Longitudinal Study of Patients Undergoing Total Joint Arthroplasty,” which appears in the January 2022 edition of Clinical Orthopaedics and Related Research.

“Despite great interest in improving patient-centered care by increased shared decision-making [SDM], and despite good evidence for its beneficial effects on patient knowledge, confidence, and satisfaction with care, there is so far no evidence as to whether it also improves clinical outcomes,” Senior Investigator Leif Solberg, M.D. of HealthPartners Institute stated to OTW. “Thus, there is relatively little use of systematic use of shared decision-making in practice, despite CMS [Centers for Medicare and Medicaid Services] increasingly requiring its use for reimbursement. Such evidence is badly needed to spur greater use.”

The authors designed an observational study where they collected survey data prior to surgery for patients receiving a primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) and then again 12 months postoperatively. The team used the collaboRATE measure of shared decision making, as well as existing patient surveys of patient reported outcome measure, noting that at the time, neither the surgeons nor the department had an organized approach to shared decision making. The Oxford knee or hip score, the patient rating of the provider, and whether a patient would recommend the provider were also assessed.

In the final analysis, 48% (1,334 procedures) of the patients responded to both the preoperative and 12-month postoperative surveys (859 TKAs and 485 THAs). The vast majority of patients included in the analytic sample were white (93%); 3% used Medicaid benefits at the time of surgery.

Dr. Solberg summarized the results of the study to OTW, “We demonstrated in 1,334 hip or knee replacement patients that increased shared decision-making pre-operatively was associated with higher joint function and patient ratings of their surgeons at 12 months after surgery. In other words, if patients felt more involved in the decision to have surgery, their outcomes were actually better.”

“Wider knowledge of these findings should stimulate greater efforts by clinicians and care systems to engage their patients in the important decisions about care. Hopefully, it will also stimulate more studies of this relationship, especially studies that randomize patients to varying amounts and types of shared decision-making so we can learn whether this association is causative.”