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Vanessa B Hurley,1 Yue Wang,2 Hector P Rodriguez,3 Stephen M Shortell,3 Stephen Kearing,4 Lucy A Savitz5 1Health Systems Administration, Georgetown University, Washington, DC 20057, USA; 2Tile, San Mateo, CA 94403, USA; 3Health Policy and Management, University of California, Berkeley School of Public Health, Berkeley, CA 94720, USA; 4High Value Healthcare Collaborative, Hanover, NH 03755, USA; 5Center for Health Research (Northwest and Hawaii), Health Research, Kaiser Permanente, Portland, OR 97227, USACorrespondence: Vanessa B HurleyHealth Systems Administration, Georgetown University, St. Mary’s Hall 231, 3700 Reservoir Road, NW, Washington, DC 20057, USATel +1 202-687-4209Email vh151@georgetown.eduBackground: Shared decision making (SDM) research has emphasized the role of decision aids (DAs) for helping patients make treatment decisions reflective of their preferences, yet there have been few collaborative multi-institutional efforts to integrate DAs in orthopedic consultations and primary care encounters.Objective: In the context of routine DA implementation for SDM, we investigate which patient-level characteristics are associated with patient preferences for surgery versus medical management before and after exposure to DAs. We explored whether DA implementation in primary care encounters was associated with greater shifts in patients’ treatment preferences after exposure to DAs compared to DA implementation in orthopedic consultations.Design: Retrospective cohort study.Setting: 10 High Value Healthcare Collaborative (HVHC) health systems.Study participants: A total of 495 hip and 1343 adult knee osteoarthritis patients who were exposed to DAs within HVHC systems between July 2012 to June 2015.Results: Nearly 20% of knee patients and 17% of hip patients remained uncertain about their treatment preferences after viewing DAs. Older patients and patients with high pain levels had an increased preference for surgery. Older patients receiving DAs from three HVHC systems that transitioned DA implementation from orthopedics into primary care had lower odds of preferring surgery after DA exposure compared to older patients in seven HVHC systems that only implemented DAs for orthopedic consultations.Conclusion: Patients’ treatment preferences were largely stable over time, highlighting that DAs for SDM largely do not necessarily shift preferences. DAs and SDM processes should be targeted at older adults and patients reporting high pain levels. Initiating treatment conversations in primary versus specialty care settings may also have important implications for engagement of patients in SDM via DAs.Keywords: shared decision making, patient engagement, patient preferences, quality of care, health systems, collaborative learning

Kimberly D Brunisholz,1,2,* Pascal Briot,1,2,* Sharon Hamilton,1 Elizabeth A Joy,3 Michael Lomax,2 Nathan Barton,2 Ruthann Cunningham,3 Lucy A Savitz,2 Wayne Cannon1 1Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA; 2Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA; 3Office of Research, Intermountain Healthcare, Salt Lake City, UT, USA*Joint first authors Purpose: The purpose of this study was to determine the impact of diabetes self-management education (DSME) in improving processes and outcomes of diabetes care as measured by a five component diabetes bundle and HbA1c, in individuals with type 2 diabetes mellitus (T2DM). Methods: A retrospective analysis was performed for adult T2DM patients who received DSME training in 2011–2012 from an accredited American Diabetes Association center at Intermountain Healthcare (IH) and had an HbA1c measurement within the prior 3 months and 2–6 months after completing their first DSME visit. Control patients were selected from the same clinics as case-patients using random number generator to achieve a 1 to 4 ratio. Case and control patients were included if 1) pre-education HbA1c was between 6.0%–14.0%; 2) their main provider was a primary care physician; 3) they met the national Healthcare Effectiveness Data and Information Set criteria for inclusion in the IH diabetes registry. The IH diabetes bundle includes retinal eye exam, nephropathy screening or prescription of angiotensin converting enzyme or angiotensin receptor blocker; blood pressure