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.