shared decision making an overview of knowledge, policy and quality measurement michael j. barry, md...
TRANSCRIPT
Shared Decision MakingAn Overview of Knowledge,
Policy and Quality Measurement
Michael J. Barry, MDPresident
March 2, 2011
Medical Directors Meeting
ABOUT US
We Believe Patients Should Be
State of our knowledge: the problem
State of our knowledge: the problem
Variation PictureEssentially Unchanged
Medical Practice Variation40 Years of Research
Documenting Inconsistent Care
The DECISIONS Study
A Portrait of How Americans Make Common Medical
Decisions
Mick Couper & ColleaguesInstitute for Social ResearchUniversity of Michigan
The DECISIONS StudyTelephone survey of a national, representative sample of 3,010 Americans age 40+
Surgery– Back surgery– knee/hip replacement– cataract extraction
Cancer screening– Prostate– Colorectal– Breast
Medications– Hypertension– Hyperlipidemia– Depression
What Have We Learned?
• Lack of balanced representation of risk (cons)• Patient opinion often unacknowledged• Physician recommendation trumps decision
process• Knowledge scores quite concerning
Poor Decision QualityPoor Decision Quality
Patients: Making Decisions in
the Face of Avoidable
Ignorance
Clinicians: Poorly “Diagnosing” Patients’ Preferences
State of our knowledge: the solution
State of our knowledge: the solution
The Evidence Strengthens
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
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 X
University of Washington X X
Allegheny 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
Policy TrendsPolicy Trends
Shared Decision Making Policy Adoption TrendsShared Decision Making Policy Adoption Trends
“As we have more and more evidence about how complex health and health care are, the need is growing exponentially for thoughtful, careful assessment by patients, working with their doctors and with access to evidence through shared decision making tools.”
Alliance for Health Reform Capitol Hill Briefing on Shared Decision MakingFebruary 14, 2011
Helen Darling
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 AppropriatedAuthorized 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
Quality MeasurementQuality Measurement
Decision QualityKey Constructs:• Patient knows there is a decision to be made• Patient knows the reasonable options• Patient learns about pros and cons of each
option• Patient goals and concerns are part of the
decision process
Policy to Support Quality Standards
• Patient Centered Medical Home• Medical “neighborhoods”/ACOs• NQF Eight Priority Areas• CAHPS• Patient Decision Aid Certification• Meaningful Use and HIT• Leapfrog Group
The Role of Health PlansThe Role of Health Plans
For Consideration
• Support use of certified patient decision support tools
• Collaborate on quality measurement• Create innovative benefit design to include
shared decision making
