decision aids enhancing the patient experience annie leblanc phd wiser choices program knowledge and...
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Decision AidsEnhancing the Patient Experience
Annie LeBlanc PhD
Wiser Choices Program Knowledge and Evaluation Research Unit
Disclosures
Relevant Financial RelationshipsNone
Off Label UsageNone
Our Decision Aids are focused on facilitating a conversation between
health professionals and patientsand thus
designed as tools intended for use during the clinical encounter
Evidence synthesisObservations
clinical encounter
DesignersStudy team
Patients advisory groupsClinicians
Stakeholders
Initial prototype
Field testing Modified prototype
Final Decision Aid
The Wiser Choices Program
Statin Choice Decision aid
Acceptable to patients (OR 2.8)Improved knowledge (2.4/9)
Improved risk estimation (OR 22)Decreased decisional conflict (11/100)
Improved total trust (OR 2.6)Improved action (70% fewer Rx in low risk patients)
Short-term adherence (OR 3.4)
Weymiller et al. Arch Intern Med 2007
The Wiser Choices Program
Aspirin Choice Decision aid
The Wiser Choices Program
Osteoporosis Choice
Just as acceptable as usual care>75% MDs found helpful (+ 1 min to consultation)
Improved knowledge (1.8/9)Improved risk estimation (~RR 2)
No change in decisional conflict or trustIncreased patient participation in choice (9%)
Same rate of Rx (~50%) in low and high risk patientsAdherence evaluation is pending
Montori VM et al. Submitted
The Wiser Choices ProgramDiabetes Medication Choice Decision Aid
Glucose control in t2 diabetes
No clear evidence for a goal HbA1cComparative effectiveness data of
safety9 types of agents (+ lifestyle
modification)Many attributes per agent
Mullan RJ et al. Archives of Internal Medicine 2009
more helpful (AMD 0.38; 95%CI, 0.04-0.72)
improved knowledge (AMD 1.10; 95%CI, 0.11-2.09); and had more involvement
in making decisions (AMD 21.8; 95%CI, 13.0-30.5)
6-mo perfect medication use (100% of days covered)
better adherence (AMD, 9% more days covered; 95%CI, 4%-14%)
persistence (AMD, 12 more days covered; 95% CI, 3-21 days)
no significant impact on HbA1c levels (AMD, 0.01; 95%CI, −0.49 to 0.50)
Interactive Diabetes Cards
The Wiser Choices ProgramOther Wiser Choices
Decision aids
Chronic care
Depression Choice (AHRQ)Genomic Cardiovasular Choice
HypertensionRosiglitazone (Avandia)
Acute care
Chest Pain Choice AMI Choice
Periop Smoking
13 Wiser Choices Decision aidsChronic & acute care
Primary care & subspecialty & ERIn/out patient settings
Rural & urban communities>50 sites
> 200 clinicians> 600 patients
Shared Decision Making
National Resource Center
Wiser Choices Program Knowledge and Evaluation Research Unit
Contributions Patient Protection and Affordable
Care Act
Develop & evaluate patient decision aidsDefine international standards
Educate and train care providersAdopt and use decision aids at point of
careContribute to statewide implementation
efforts
Internal Partners
AskMayoExpert
Program inProf. & Ethics
MayoClinic.com
PatientEducation
CenterWiser
Choices Program
Center for Innovation
Dept. ofDevelopment
Center for SocialMedia
Health PolicyCenter
OneVoice
SDMNRCenter
Center Websitehttp://shareddecisions.mayoclinic.org
BlogAnnouncements (events)
ResourcesResearch
News articles
Creating a conversation
Evidence synthesisTranslation of evidence into action
Patient important researchDesign of carearound the needs of the patient
Improve value of healthcare to the patientMinimally disruptive
medicineFIT
Shared decision making
http://kerunit.e-bm.orghttp://kercards.e-bm.info
http://shareddecisions.mayoclinic.org