Shared Decision MakingWe’re in This Together

Michael J. Barry, MDPresident

We Believe Patients Should Be

Supported & encouraged to participate in their health care decisions

Fully informed with accurate, unbiased & understandable information

Respected by having their goals & concerns honored

Why Shared Decision Making in Health Care?

Evidence of the Problem

The DECISIONS StudyA Portrait of How Americans Make

Common Medical Decisions

Medical Practice Variation40 Years of Research

Documenting Inconsistent Care

Poor Decision Quality

Patients: Making Decisions in

the Face of Avoidable

Ignorance

Clinicians: Poorly “Diagnosing” Patients’ Preferences

Shared Decision Making

(Charles C, Soc Sci Med 1997; 44:681)

Clinician and patient work together

They share information About options and outcomes

About preferences

They work toward a consensus about the preferred test or treatment

They reach an agreement on the test or treatment to implement

Supporting the Concept SDM supported by patient

decision aids improves decision quality

Both patients and physicians support SDM

Implementation models are demonstrating that SDM can work “in the trenches”

O’Connor et al. Cochrane Database of

Systematic Reviews, 2009

Foundation Demonstration Sites Primary Care Specialty Care

Dartmouth Hitchcock Medical Center XWhite River Junction VA XMassachusetts General Hospital XUniversity of North Carolina XMaine Health XMercy Clinics Inc. XStillwater Medical Group XOregon Rural Practice Based Research Network XPalo Alto Medical Research Foundation X XGroup Health Cooperative X

Everett Clinic X XMulti-Care Health System X XVirginia Mason Medical Center X XAllegheny General Hospital - Breast Center XCarol Milgard Breast Care Center XUniversity of California San Francisco - Breast Center XDHMC - Breast Center XDHMC - Urology XDHMC - Orthopedics XDHMC - Spine Center XDHMC - Cardiology X

Non-Funded Demonstration SitesMackey Family Practice XPeace Health (Oregon) XMercy Cancer Center (Oklahoma) X

Shared Decision Making

TRENDS

Patient Protection and Affordable Care Act

HR3590 Section 936Program to Facilitate Shared Decision Making To facilitate collaborative process between patients and

providers .. and to incorporate patient preferences and values into medical plan

Authorized not Appropriated

Key Aspects of PPACA Section 936

1. Produce patient decision aids2. Set quality standards and certify decision aids3. Create Shared Decision Making Resource Centers4. Grant funds to providers for development, use and

assessment of SDM techniques using certified decision aids

Section 3021 CMS Innovation Center Test innovative payment models to reduce

expenditures and to enhance quality of care

Option #9Assisting applicable individuals in making informed health care

choices by paying providers for using patient decision support tools that improve individual understanding of medical options

Section 931 Quality Measures DevelopmentAssessment of experience, use and quality of information provided to

patients to inform decision making including the use of SDM tools

Shared Decision Making is at the Core of Ethical, Patient Centered

Care

Patient Centered Medical Home Accountable Care Organizations

Meaningful Use of Health Information Technology (HIT)

Thank You!

mbarry@fimdm.org

www.informedmedicaldecisions.org