Effects of implementing Shared
Decision Making in Knee
replacement pathway
Alan Nye
Neil 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.