Patient Decision Aids into Routine Orthopedic Care: Results from an Implementation Study at 12 Sites

Background Decision aids (DAs) are evidence-based tools to improve patient-centered care, but their use in routine care is limited. The purpose of this project was to work with orthopedic practices to deliver DAs. Methods Eligible sites needed to identify an administrative and clinical champion and have access to DAs for treatment of hip, knee, and/or spine conditions. The implementation strategies included an Orthopaedic Learning Collaborative (OLC), external facilitation, and audit and feedback. The project was conducted over 15 mo with 5 OLC sessions, individual monthly meetings, and monthly data reports. Clinicians and staff completed a baseline survey prior to the start of the project. Sites provided details on their DA workflow and number of DAs delivered. We calculated adoption (the number of specialists who used DAs) and estimated reach (percentage of eligible patients who received DAs). We calculated descriptive statistics and explored predictors of reach. Results Twelve participating sites had an average annual orthopedic surgical volume of 550, half were academic medical centers, and some (4/13, 30.7%) had prior experience with orthopedic DAs. Adoption was 76% (60/79 physicians). Sites distributed 9,626 DAs and reached 44% of eligible patients (range 7%–100%). Sites that indicated at baseline that DA delivery was a high priority for staff had higher reach (60% reach for high v. 47% for moderate v. 9% for low priority, P = 0.21). Sites with no prior experience with DAs had higher reach than those with prior experience did (60% v. 38%, P = 0.26, d = 0.71). Conclusions Participating sites were able to implement workflows that reached about half of eligible patients. Establishing DA delivery as a priority for staff at the outset appears important for reach, while prior experience does not. Highlights The 12 sites were able to reach, on average, 44% of eligible patients with decision aids in routine care demonstrating feasibility of distribution. The study and associated implementation toolkit provide concrete examples of workflows for orthopedic practices interested in incorporating decision aids into routine care. A bundle of implementation strategies, including a learning collaborative, external facilitation, and audit and feedback, helped most sites meet targets for decision aid implementation.