Helping patient with choices in preference-sensitive care

March 3, 2011 | Matt Handley MD

Shared Decision Making at Group Health

The HistoryThe History

Legislation in 2008 leads to a statewide collaborative

Commitment to systematic implementation within the group practice at GHC in 2009◦Aligned leadership◦ Incorporation into evolving standard work in

specialty

Evidence for using decision aids

Patient-centered care at Group Health

20052005

20072007

20092009Implementationtimeline

ImplementationImplementation

Case for change with specialty leadership◦Variable uptake over time

Distribution of decision aids◦ Integration into EMR as an orderable activity

– triggers mailing of DVD to home◦Tools in EMR to link to streaming decision

aids on MyGroupHealthIncorporation into evolving standard

work in specialty

Providers can order through Epic

Distributing decision aids

DVDs can be ordered for

mailing or viewed on the

Web

Treatment choices in 6 specialty areas

1

2

3

4

5

6

12 preference-sensitive conditions

1. Hip osteoarthritis

2. Knee osteoarthritis

3. Coronary artery disease

4. Benign prostatic hyperplasia

5. Prostate cancer

6. Uterine fibroids

7. Abnormal uterine bleeding

8. Early stage9. Ductal

carcinoma in situ

10. Breast reconstruction

11. Spinal stenosis

12. Herniated disc

Evaluation

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

2009 2010

Percentage of procedures for preference sensitive conditions where patient did not receive the video

Fewer missed opportunities

Patient assessment

Overall rating of decision aid videosPatient survey, March 2010, 400 responses

Helped you understand the treatment choices

Helped you prepare to talk with provider

Patient assessment

Overall rating of decision aid videosPatient survey, March 2010, 400 responses

How important is it that providers make programs like this available?

Rating of decision aid videos, by topic

March 2010

Patient assessment

First year resultsFirst year results

Aiming for publication this year, so we are not sharing numbers

Impact has led us to deepen our commitment to SDM

Next stepsNext steps

Development of our surgical group’s skills in facilitating SDM conversation◦Training in May, co-developed with FIMDM

Engagement with back care, general surgery

Feedback of information about defects (patients receiving surgery without exposure to the decision aid)

What are we Relearning?What are we Relearning?

Implementation is not a binary eventTechnical change (distribution of the

decision aids) is much easier than Adaptive change (having very different conversations with patients)

We have a great medical groupImplementation in our network is

dramatically more challenging than within our group practice

Questions?