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Equity, Health Quality and Shared Decision Making,[object Object],Aligning Forces for Quality National Meeting,[object Object],Using Health Information for Decision Making:  The Consumer Perspective,[object Object],Lyn Paget, MPH,[object Object],May 13, 2010,[object Object]
We Believe Patients Should Be,[object Object]
Equity, Health Quality and Shared Decision Making
Shared decision making is an essential ingredient of patient centered care.,[object Object]
Every medical encounter involves decisions,[object Object]
Shared Decision Making,[object Object],Interactive process between patient and clinician,[object Object],Engages the patient in decision making,[object Object],Provides patient with accurate, unbiased and understandable information about choices (risks & benefits associated with choice),[object Object],Incorporates patient’s preferences and values,[object Object],(Charles C, Soc Sci Med 1997; 44:681),[object Object]
Equity, Health Quality and Shared Decision Making
What is on the Policy Horizon?,[object Object]
Federal Health Care Reform,[object Object],HR3590 Section 936,[object Object],Program to Facilitate Shared Decision Making ,[object Object],Purpose is to facilitate collaborative process between patients and providers .. and to incorporate patient preferences and values into medical plan.,[object Object]
Key Aspects of Legislation,[object Object],Priority - preference sensitive care,[object Object],Produce patient decision aids,[object Object],Set quality standards & certify decision aids,[object Object],Create Shared Decision Making Resource Centers,[object Object],Provider development, use and assessment of SDM techniques using certified decision aids,[object Object]
Section 3021 CMS Innovation Center ,[object Object],Test innovative payment models to reduce expenditures and to enhance quality of care.,[object Object],18 different models,[object Object],9) “Assisting applicable individuals in making informed health care choices by paying providers  for using patient decision support tools that improve individual understanding of medical options”,[object Object]
Patient Centered Medical Home,[object Object],Accountable Care Organizations,[object Object],Meaningful use of HIT,[object Object],All providing opportunities to incorporate shared decision making,[object Object],Also,[object Object]
State Policy and Reform,[object Object]
States Explore Shared Decision Making,[object Object],Bridget M. Kuehn ,[object Object],JAMA. 2009;301(24):2539-2541.,[object Object]
Equity, Health Quality and Shared Decision Making
Common Elements,[object Object],[object Object]
Platform for pilot projects
Certification/quality standards
Professional training
Evaluation,[object Object]
Supporting the Concept,[object Object],[object Object]
Both patients and physicians support it
Models are demonstrating value/benefitO’Connor et al. Cochrane Database of Systematic Reviews, 2009,[object Object]
Foundation Demonstration Sites,[object Object],A diverse group of provider organizations,[object Object],Academic and community-based,[object Object],Primary care and specialty care,[object Object],Developing proof of concept that DAs and shared decision making can be efficiently and effectively incorporated into clinical practice,[object Object],Utilizing a common data set aggregated by the Foundation,[object Object],19,[object Object]
Equity, Health Quality and Shared Decision Making
Implementation Tasks,[object Object]
Equity, Health Quality and Shared Decision Making
System-wide implementation for 12 elective surgical procedures,[object Object],Patient portal viewing,[object Object],New EPIC Smart Phrases to document informed consent,[object Object],	 – pre and post decision aid conversation,[object Object],Tracking Outcomes:,[object Object],Decision aid viewing on Web and DVDs,[object Object],Patient satisfaction ,[object Object],Procedure rates,[object Object],Overall health care use of patients (# visits, hospitalizations, Rx),[object Object],Cost of health care for patients,[object Object],Cost of decision aid implementation and delivery,[object Object],Impact of SDM implementation on providers and staff,[object Object],State Legislated Demonstration Project,[object Object]
Demonstrating and Understanding Value,[object Object]
Decisions, Decisions,[object Object],Doctors are using new tools to help patients make choices about treatment options.,[object Object],Urologist and surgeon ,[object Object],Thomas Stormont, M.D.,[object Object],“It’s made my job easier,” he says, “and the patients feel more empowered and in control of their cancer.”,[object Object]
Shared Decision Making and Targeted Communities,[object Object]
What We Know,[object Object],[object Object]
Greater need for extra information/support
With info/support in place – benefit at least as much as others,[object Object]
Men who attended college and men who did not
Less educated start with less knowledge/readiness
Post PDA comparable increases,[object Object]
desire to be involved
recommending others use PDAs,[object Object]

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