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

BackgroundDecision 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.MethodsEligible 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.ResultsTwelve 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,