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

Karen Sepucha1,2, Ha Vo2, Felisha Marques2

  • 1Harvard Medical School, Boston, MA, USA.

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|December 24, 2025
PubMed
Summary

Orthopedic practices successfully implemented decision aids (DAs) reaching 44% of eligible patients. Prioritizing DA delivery and using implementation support were key factors for success in routine care.

Keywords:
decision makingdecision support techniqueslearning collaborativelumbarquality improvementsharedspinetotal hip arthroplastytotal knee arthroplasty

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Area of Science:

  • Health Services Research
  • Patient-Centered Care
  • Implementation Science

Background:

  • Decision aids (DAs) are evidence-based tools crucial for enhancing patient-centered care.
  • Limited integration of DAs into routine clinical practice necessitates effective implementation strategies.

Purpose of the Study:

  • To partner with orthopedic practices to implement and evaluate the delivery of decision aids (DAs).
  • To assess the feasibility and effectiveness of a multi-component implementation strategy in orthopedic settings.

Main Methods:

  • A 15-month implementation project involving 12 orthopedic sites.
  • Utilized an Orthopaedic Learning Collaborative (OLC), external facilitation, and audit/feedback mechanisms.
  • Measured adoption rates among specialists and estimated reach (percentage of eligible patients receiving DAs).

Main Results:

  • Achieved 76% adoption among physicians, distributing 9,626 DAs.
  • Reached an average of 44% of eligible patients, with significant variation (7%-100%).
  • Higher reach was associated with prioritizing DA delivery at baseline and lack of prior DA experience.

Conclusions:

  • Orthopedic practices can integrate decision aids into routine care, reaching a substantial proportion of patients.
  • Establishing DA delivery as a staff priority is crucial for successful implementation.
  • Implementation support strategies, including collaborative learning and feedback, facilitate DA adoption.