Effects of implementing Shared Decision Making in Knee

replacement pathway

Alan NyeNeil Parkinson

Introduction• Pennine MSK

– Innovative service in Oldham delivering Rheumatology, elective orthopaedics and MSK chronic pain

– Clinically owned, manages £23m programme budget, runs with Modified Specialist PMS contract

• Shared Decision Making– Tested and Implemented the AQuA model past 2 years– Looked at impact of implementing SDM on patient reported outcomes

for those who have had knee arthroplasty, year before implementation compared to the two years since

– Already know SDM results in patient expectations being more realistic– High dissatisfaction in knee arthroplasty (19% of patient ambivalent

about or regret surgery)– Joint project with NHS England

Shared Decision Making Implementation

• Developed and trialed the NHS patient decision aids• Staff training• Organisation changes – standard board reports, staff

induction, measuring decisional conflict• Patient empowerment – Ask three questions• AQuA collaborative• All patients:– Given A3Q leaflets– Signposted to PDAs– All front line staff trained in SDM, many in Motivational

Interviewing too

Patients in Oldham are getting better health outcomes

Used Patient Reported Outcome Measures (PROMs) data on EQ-5D index to show:

•Oldham’s knee replacement patients received an average health gain of 0.27 in 2009/10 and 0.35 by 2011/12.•A statistically and clinically significant increase in Oldham’s patients health outcomes.•The England average health gain was 0.30 throughout the period.

Period of improvement matches the introduction of SDM.

•Involving patients in decision to treat appears to lead to better outcomes.

•Treated increasingly sicker patients in Oldham, but restored to same good health level.

Improvement delivered within financial constraints in period with:

•Arthroscopies growing at 8% in Oldham compared to 12% nationally.

•Musculoskeletal spend per head decreasing by £10 in Oldham compared to an increase of £10 nationally.