Shared Decision MakingModerator: David McCulloch, MD
Panel: Chris Cable, MDJenny Fry, LPNCharlie Jung, MDDiana Leback, RN, MS
What is shared decision making?
Togetherthey
make a decision
Patientsconsider options
Doctorsshare
information
When is shared decision making most useful?
More than one treatment
option
More than one treatment
option“Preference
sensitive” conditions
“Preference sensitive” conditions
Little evidence for one choice over another
What are decision aids?
Resources that help patients make informed decisions with their providers
Resources that help patients make informed decisions with their providers
Information about
a patient’s health
condition
Information about
a patient’s health
condition
Treatment options,
risks & benefits
Treatment options,
risks & benefits
Brochures, DVDs,
web tools
What are the characteristics of decision aids?
Evidence-based, frequently updated, balanced
Evidence-based, frequently updated, balanced
Help patients clarify values &
preferences
Help patients clarify values &
preferences
Guide patients in communication
with doctors
Evidence for using decision aids
• Increased knowledge• More active patient participation • Better alignment between values & choices
34 randomized controlled trials
• Lower surgery rates• No evidence of harms from not having
surgery
7 randomized controlled trials
• Higher patient knowledge & satisfaction• Lower surgery rates with similar outcomes
2 Group Health studies
Decision aids at Group Health
Research
System-wide implementation
2-year research project
Foundation support
Patient-centered care at Group Health
Shared electronic medical record
Medical home pilot
Decision aids for shared decision making
20052005
20072007
20092009
Implementationtimeline 20112011
Evaluation of decision aids continues
Treatment choices in 6 specialty areas
OrthopedicsOrthopedics
CardiologyCardiology
UrologyUrology
Women’s healthWomen’s health
Breast cancerBreast cancer
Back careBack care
1
2
3
4
5
6
Aims of the evaluation
Assess impact on surgery useAssess impact on surgery use
Assess impact on total health care use and costs
Assess impact on total health care use and costs
Estimate ROI from health plan and purchasers’ viewEstimate ROI from health plan and purchasers’ view
Assess process barriers and facilitators
Assess process barriers and facilitators
12 preference-sensitive conditions
Orthopedics Cardiology Urology
Women’s Health
Breast Cancer Back Care
1. Hip osteoarthritis
2. Knee osteoarthritis
3. Coronary artery disease
4. Benign prostatic hyperplasia
5. Prostate cancer
6. Uterine fibroids
7. Abnormal uterine bleeding
11. Spinal stenosis
12. Herniated disc
8. Early stage9. Ductal
carcinoma in situ
10. Breast reconstruction
What are we learning about use of decision aids at Group Health?
Providers can order through Epic
Distributing decision aids
DVDs can be ordered for
mailing or viewed on the
Web
Evaluation
Ordering & viewingOrdering & viewing
Provider interviewsProvider interviews
Patient survey link
Patient survey link
Decision aid distribution
Number of videos distributed, by month Total: 8,808*
*As of 12/31/2010; does not include decision aids viewed on the web after Oct 2009
Jan Apr Jul Oct Jan Apr Jul Oct2009 2010
Decision aid distribution in Ortho
0
100
200
300
Videos
Jan 09 Jul 09 Jan 10 Jul 10 Jan 11Month
Hip Osteoarthritis Knee Osteoarthritis
Orthopedics: Service Line Video Distribution
Implementationof PDP work
2009 2010
Percentage of procedures for preference sensitive conditions where patient did not receive the video
Fewer missed opportunities
Overall rating of decision aid videosPatient survey, September2010, 950 responses
Helped you understand the treatment choices
Helped you prepare to talk with provider
Patient assessment
Patient assessment
Overall rating of decision aid videosPatient survey, September 2010, 975 responses
How important is it that providers make programs like this available?
Rating of decision aid videos, by topicSeptember 2010
Patient assessmentHelped understand treatment choices
Helped prepare to talk with provider
How important that providers make programs like this available
Excellent or very good Extremely or very importantPercent of patients rating:
Problems/issues/things to improve…?
Getting the right patient at the right time.Knowing that the patient watched the DA.Knowing that a follow-up conversation took
place.Tracking which patients watched the DA and
decided NOT to have surgery at this time.Getting follow-up with patients at 12mo+ to
check if they were happy with their decision.
Top Related