{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T22:37:01Z","timestamp":1771886221137,"version":"3.50.1"},"reference-count":38,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/100000936","name":"Gordon and Betty Moore Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000936","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2017,11,5]]},"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To integrate patient decision aid (DA) delivery to promote shared decision-making and provide more patient-centred care within an orthopaedic surgery department for treatment of hip and knee osteoarthritis, lumbar herniated disc and lumbar spinal stenosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Different strategies were used across three distinct phases to promote DA delivery. First, we used a quality improvement bonus to generate awareness and interest in the DAs among specialists. Second, we adapted the electronic referral management system to enable DA orders at referral to a specialist. Third, we engaged clinic staff and specialists to design workflows that promoted DA delivery. We tracked the number of patients who received a DA, who ordered the DA, and collected usage data from a subset of patients. Our target was to reach 60% of patients with DAs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In phase 1, 28% (43\/155) of spine patients and 37% (114\/308) of hip\/knee patients received a DA. In phase 2, 54% (64\/118) of spine referrals and 58% (189\/324) of hip\/knee referrals included a request to send a patient a DA. In phase 3, 56% (90\/162) of spine patients and 69% (213\/307) of hip\/knee patients received a DA, significantly more than in phase 1 (P&lt;0.0001). In phase 3, both more DAs were ordered by clinic staff compared with specialists (56% phase 3 vs 34% phase 1, P&lt;0.001) and sent before the visit (74% phase 3 vs 17% phase 1, P&lt;0.001). Patients were more likely to report reviewing the DA when delivered before the visit (63% before vs 50% after, P=0.005).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>DA implementation into clinic workflow is possible and facilitated by engagement of the entire care team and the support of health information technology.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2017-007019","type":"journal-article","created":{"date-parts":[[2017,11,24]],"date-time":"2017-11-24T12:21:37Z","timestamp":1511526097000},"page":"347-354","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Increasing the use of patient decision aids in orthopaedic care: results of a quality improvement project"],"prefix":"10.1136","volume":"27","author":[{"given":"Mahima","family":"Mangla","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas D","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet M","family":"Dorrwachter","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew A","family":"Freiberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, 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