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Presentation given at the Foundation's Jan. 26 Research and Policy Forum by Richard Wexler, MD, director of Patient Support Strategies for the Foundation.
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Richard Wexler, MDDirector, Patient Support Strategies
Shared Decision Making in Primary Care
Moving From Concept to Reality
Presentation Outline
• Provide a brief overview of our Foundation’s demonstration site program
• Share a few findings from the sites • Offer a context for the
presentations and video which follow
Overview – Program Objective
To demonstrate that the use of patient decision aids (DAs) and the process of shared decision making (SDM) can become part of routine care
Overview – Program Objective• We are establishing proof of concept• Practical question: how strong does the
case have to be?• Considerations
– Level of proof required by target audience– Potential harm of intervention– Potential benefit of intervention
• Is there an ethical imperative
– Financial cost of intervention– Time required to attain “proof”– Leveling the playing field
Funded Demonstration Sites Primary Care Specialty Care
Massachusetts General Hospital X
University of North Carolina X
Maine Health X
Mercy Clinics Inc. X
Stillwater Medical Group X
Oregon Rural Practice Based Research Network X
Palo Alto Medical Research Foundation X
Group Health Cooperative X XUniversity of Washington X XAllegheny General Hospital - Breast Center X
University of California San Francisco - Breast Center X
Dartmouth Hitchcock Medical Center (DHMC) - Breast Center X
DHMC - Urology X
DHMC - Orthopedics X
DHMC - Spine Center X
DHMC - Cardiology X
Overview – The “Sites”
Overview - Support
• Sponsorship includes– Financial support– Technical support– Participation in a learning community– Data aggregation and analysis
• Sponsorship duration – one to five years
Overview – Strategy
• Focus on Primary Care– Primary care as a source of unbiased
information– Use of patient decision aids prior to
referral for elective surgery for preference sensitive care
– Align with “Patient Centered” Medical Home and ACO movements
Overview – Strategy
• Recruit for success– Cultural commitment to quality
improvement– Strong leadership support for SDM– Supporting infrastructure– Track record of success
• Establish clear objectives up front
Overview - Strategy
Establish Conceptual Framework
©Copyright 2010 Foundation for Informed Medical Decision Making All Rights Reserved
Overview - Strategy
• Measurement strategy– Patient questionnaires– Data aggregation and analysis– Provider and staff satisfaction
surveys– Focus group guides– Implementation tracking sheets
Presentation Outline
• Provide a brief overview of our Foundation’s demonstration site program
• Share a few findings from their work
• Offer a context for the presentations and video which follow
Demonstration Sites – Returned QuestionnairesJuly 2009 to January 2011
Acute Low Back PainAdjuvant Breast Cancer TherapyBreast ReconstructionBreast Cancer SurgeryBenign Prostatic HyperplasiaAbnormal Uterine BleedingUterine FibroidsCoronary Artery DiseaseDuctal Carcinoma in SituDepressionHerniated DiscHip OsteoarthritisKnee OsteoarthritisMenopauseProstate CancerSpinal StenosisWeight Loss Surgery
Preference-Sensitive
n=1661 Colorectal Cancer Screening
PSA Testing
Screening n=539
Patient Responses After Viewing DA:Overall how would you rate the program?
Data submitted to Illume data warehouse as of 4-January-2011
n=1571
n=458
Patient Responses After Viewing DA:How important for clinicians to give DAs to
patients?
Data submitted to Illume data warehouse as of 4-January-2011
n=780
n=264
Patient Responses After Receiving DA:How much of the video did you watch?
Data submitted to Illume data warehouse as of 4-January-2011
n=1582
n=472
Percentage of Correctly Answered Knowledge Questions
By Amount of Video Watched
Data submitted to Illume data warehouse as of 4-January-2011
n=546
n=144
NOTE: Does not include patients who read ALL of booklet
* Scores for patients who watched NONE or ALL of the video are statistically significantly different at the p<.05 level
Patient Responses Before & After Viewing DA:How far along are you with this decision?
Before DA
After DA
Preference-Sensitive
Before DA
After DA
Screening
Decided/Close to deciding
Not thought about it/Considering options
Data submitted to Illume data warehouse as of 4-January-2011
* NOTE: All before/after comparisons are statistically significantly different at the p<.05 level
Patient Responses Before & After Viewing DA:What are you leaning toward doing?
Before DA
After DA
Before DA
After DA
Before DA
After DA
CRC ScreeningSurgery PSA Screening
Data submitted to Illume data warehouse as of 4-January-2011
n=914
n=162
n=332
Thank You
Change that Works
