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 making patient decision aids—shown to increase knowledge and support informed decision making—part of routine orthopedic care.

Orthopedic conditions, such as osteoarthritis and low back pain, are leading causes of disability in the United States. Surgery is a common treatment. Each year, more than 1 million hip or knee replacements take place. However, many patients make a choice without fully understanding the trade-offs between the benefits and harms of surgery.

What is the goal of this implementation project?

For many orthopedic health problems, patients can choose between surgery and non-surgery treatment options like medicine or physical therapy. A PCORI-funded research study found that two decision aids helped patients with hip and knee osteoarthritis learn about their treatment options and make decisions based on what’s most important to them.

This project will make the tested decision aids, and others like them, a part of routine care for patients looking at treatment for one of four orthopedic problems:

  • Hip and knee osteoarthritis, which causes the cartilage in joints to wear away, resulting in painful or stiff joints
  • Lumbar herniated disc, a problem with the cushion-like pads, or discs, between vertebrae in the spine, resulting in back and leg pain
  • Spinal stenosis, a narrowing of space in the spine that causes back and leg pain and can make it hard to move

What will this project do?

Twelve orthopedic centers across several states are taking part in the project. The project team is first working with four of these centers to figure out the best ways to make the decision aids part of routine care. Then the project team is hosting a Learning Collaborative for all 12 centers as they work to adopt the decision aids.

At each center, two staff—a clinician and an administrator—are leading the work and promoting use of the decision aids. The project team is providing support through:

  • Site visits and in-person meetings
  • Discussion sessions with clinicians and staff from all sites to talk about successes and challenges in using the decision aids
  • Clinician and staff peer-to-peer check-ins

The project team is also creating resources to help centers use the decision aids. The resources include:

  • Sample workflows of using the decision aids and staff roles
  • Training materials
  • A dashboard to track decision aid use and shared decision making and to analyze data

What is the expected impact of this project?

This project will show what’s required to put patient decision aids in place for routine orthopedic care. More than 13,000 patients who are considering orthopedic surgery will use the decision aids. The project evaluation will confirm that the decision aids work as intended to support informed decision making.

More about this implementation project: 

Stakeholders Involved in This Project

  • The American Academy of Orthopaedic Surgeons (AAOS)

Implementation Strategies

  •  Promote shared decision making. 
  •  Adapt the shared decision making approach, including plans for decision aid integration, to work with sites’ existing resources and workflows. 
  • Provide sites with tools to support implementation, including sample workflows and staff roles and a  dashboard to track decision aid use. 
  • Provide educational materials to patients, as part of decision aid. 
  • Train surgeons on shared decision making and how to use the decision aid through online modules. 
  • Use a phased implementation approach. 
  • Create a learning collaborative to support shared decision making and use of the decision aids at sites. 
  • Identify and prepare clinical and administrative champions at sites. 
  • Provide technical assistance to sites, including consultation. 

Evaluation Outcomes

To document implementation:

  • Number of decision aids delivered to patients
  • Number of clinicians and staff who participated in training
  • Number of clinicians and staff who delivered a decision aid
  • Time associated with decision aid delivery
  • Intention of sites to continue decision aid use after the learning collaborative ends

To assess healthcare and health outcomes:

  • Patient-reported level of patient shared decision making with surgeon and decision quality

Project Information

Karen R. Sepucha, PhD
Massachusetts General Hospital

Key Dates

March 2020
December 2023

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Evaluating Different Ways to Help Patients Make Informed Choices about Surgery for Knee or Hip Osteoarthritis


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: March 15, 2024