Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is using results from a recent study comparing the benefits and harms of weight loss surgery to support patients in making informed decisions about their care.

Some people with severe obesity can’t lose enough weight with diet and exercise to improve their health and quality of life. Two types of weight-loss surgery can help people with severe obesity lose weight and improve problems related to obesity, such as diabetes. Patients can work with their clinicians to consider the risks and benefits of these surgeries and make the decisions that work best for them.

What is the goal of this implementation project?

Shared decision making, or SDM, is a process in which patients and doctors work together to make healthcare decisions. A PCORI-funded research study followed more than 46,000 people with severe obesity who had weight loss surgery for five years. Depending on which surgery people chose, the study found differences in how much weight they lost after surgery, whether their diabetes improved, and whether people had another surgery.

This project is bringing the results of this study to patients who are thinking about weight loss surgery and their doctors to help them make a decision.

What will this project do?

The project team is working with weight loss, diabetes, and primary care clinics. These clinics are part of two large health systems in Washington State and Pennsylvania.

First the project team is updating two decision aids, called Option Grids, with the results from the study. Decision aids help people choose treatments based on what’s most important to them. Patients who are thinking about surgery can view the first decision aid before meeting with their clinician to discuss if surgery is right for them. Patients who’ve already decided on surgery can use the second decision aid with their surgeon to discuss which type of surgery to get.

The project team is forming local teams at each site that will:

  • Help design approaches to make the decision aids and SDM discussions part of routine care at each site
  • Oversee all activities and support care teams at their sites
  • Refine the training program for use at the sites

The project team is also:

  • Working with site leadership to make SDM a routine part of care for patients who are thinking about weight loss surgery
  • Training clinicians or surgeons at each site as clinical champions who can promote SDM
  • Providing in-person and virtual training on SDM, including role-playing
  • Working with sites to build processes into their IT systems for ordering decision aids, referring patients to specialists, and documenting use of the decision aids
  • Working with sites to provide monthly reports for clinicians that capture use of decision aids, referrals, and patients’ choice of procedures

What is the expected impact of this project?

This project will demonstrate what’s required to put the SDM process into practice at two health systems. More than 1,800 patients with severe obesity will receive support when making decisions about weight loss surgery.

The project evaluation will confirm that the process is working as intended to support SDM for patients who are thinking about surgery.

More about this implementation project:

Stakeholders Involved in This Project

  • American Society of Metabolic and Bariatric Surgery
  • Society of General Internal Medicine
  • The Obesity Society
  • Obesity Action Coalition
  • Medicare Evidence Development & Coverage Advisory Committee (convened by the Centers for Medicare and Medicaid Services)
  • Business Group on Health 

Implementation Strategies

  • Promote shared decision making. 
  • Adapt the decision aids to include results of the PCORnet® Bariatric Study. 
  • Adapt the shared decision making approach to work with sites’ existing resources and workflows. 
  • Integrate IT tools to support decision aid delivery and referrals to specialists into sites’ electronic health record system. 
  • Create and support implementation teams at sites, including clinicians, quality leaders, administrators, and patients. 
  • Provide educational materials to patients, as part of decision aid. 
  • Train primary care providers and bariatric surgeons on shared decision making, in-person and online.  
  • Provide clinicians with monthly audit and feedback reports. 
  • Identify and prepare clinical champions at sites. 
  • Provide technical assistance to sites, including consultation. 
  • Offer continuing medical education credit. 

Evaluation Outcomes

To document implementation:

  • Fidelity of implementing SDM process
  • Number of patients who receive the decision aids
  • Number of patients who have an SDM conversation (as documented by their providers)
  • Provider satisfaction

To assess healthcare and health outcomes:

  • Patient-reported measures of experience and satisfaction with SDM
  • Number of referrals to bariatric surgeons
  • Number of patients who undergo bariatric surgery and their choice of bariatric procedure
  • Patient change in weight following surgery (exploratory)

Project Information

David Arterburn, MD, MPH
Kaiser Foundation Health Plan of Washington

Key Dates

March 2019
October 2023

Study Registration Information

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Comparing Three Types of Weight Loss Surgery -- The PCORnet® Bariatric Study


Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
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Last updated: September 26, 2023