consumer-purchaser disclosure project shared decision-making discussion forum lyn paget july 1, 2009
TRANSCRIPT
Consumer-Purchaser Disclosure Project
Shared Decision-Making Discussion Forum
Lyn PagetJuly 1, 2009
Overview of Presentation
• Brief history of Foundation
• Patient Decision Aids & Shared Decision Making
• Research/Demonstrations
• Policy/Legislation
Intellectual Roots
• Variation Research
• Decision-making science & quality
• Social science
• Clinical expertise
Concept for the Foundation
Decrease unwarranted variation & increase decision quality by changing
the standard of care to one where patients are informed & involved in
medical decision making.
Simply put…
Assure that people understand their choices and have the information they
need to make sound medical decisions.
Foundation
• Patient decision aids• Research– Practical challenges of engaging
patients– Theoretical basis of decision support &
medical decision making– Decision quality
• Clinical practice demonstrations• Advance policy
Develop Patient Decision Aids
Decision Aid Development
• Literature review and synthesis• Patient and provider focus groups• Organize content (framing, key clinical
insights, data) • Recruit patients and providers for
interviews• Collaborate with Health Dialog to
develop a ‘rough cut’ for evaluation
Evaluation• What:
– Clinical accuracy, balance, acceptability, knowledge
• How:– Patients (20 - 30) who have condition or have made
decision– Medical Editor and Clinical Advisors– Foundation and Health Dialog staff– Reviewers (not involved previously)
Final program reflects evaluation input.
Review and Updates
• Every 6 months– Medical Editor reviews DVD and booklet – Clinical accuracy
• Every 2 years– Medical Editor, Clinical Advisors, Reviewers– Focus groups, 20 to 30 patients– Clinical accuracy + relevance/acceptability +
knowledge (patients)
• Programs revised as needed.
Distribution
• Health Dialog (health coaching model)
• Research sites (provider models)
Do they work?
Cochrane Collaborative
• They consistently choose less treatment & testing– Bypass surgery– Hormone replacement therapy– PSA testing– Breast cancer treatment– Prostate surgery
When patients are informed
• 70% of patients set more realistic expectations
• Less decisional conflict exists• Better match between choices and
values• 50% move from undecided to decided • Patients are 40% less passive in decision
making
When patients see DAs
The role of decision aids in shared decision-making
Clinical Demonstrations
Demonstration Site Goals
• Learn how DAs & SDM can be effectively deployed in clinical settings
• Promote system changes which encourage broad uptake of SDM
• Expand knowledge to facilitate integration of DAs & SDM
Demonstration SitesSite Primary Care Specialty Care Non-Funded
Dartmouth Hitchcock Medical Center X
White River Junction VA X
University of North Carolina X
University of San Diego X
University of Los Angeles X
Mass General Hospital X
MaineHealth X
Mercy Inc X
Stillwater X
Oregon Health Science University X
Palo Alto Medical Foundation X
Allegheny General Hospital – Breast Center X
University of California San Francisco – Breast Center
X
DHMC – Breast Center X
DHMC – Urology X
Partners Health Care X
Elyria X
Priority Health X
Implementation Tactics
• Provider engagement• Patient identification• Program distribution– Timing– Channels
• Program viewing• Closing the loop
What are we learning?
Value Enhanced
• Provider endorsement• Supportive infrastructure• Measures of decision quality• Integration in clinical pathways
How do we reach the tipping point?
Policy & Reform to Advance a New Standard
Legislation
States Explore Shared Decision Making Bridget M. Kuehn
JAMA. 2009;301(24):2539-2541.
Reforming States Group
Shared Decision-Making Seminars4 Seminars for 160+ participants46 states represented
Common Elements
• Platform for pilot projects• Clear economic incentives• Preference-sensitive conditions• Certification/quality standards• Professional training• Evaluation
Quality Standards
• Certification– Decision support
materials– Shared decision-making
process
• IPDAS work– International Patient
Decision Aids Standards– 14 countries represented
