Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Neil Korsen, MaineHealth
Larry Morrisey, Stillwater Medical Group
Charlie Brackett, Dartmouth-Hitchcock Medical Center
Grace Lin, Palo Alto Medical Foundation
Carmen Lewis, University of North Carolina
Leigh Simmons, Massachusetts General Hospital
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
Jeff Thompson, Washington State Health Care Authority
David Downs, Engaged Public
David Swieskowski, Mercy ACO Mercy Clinics, Inc.
Lisa Weiss, High Value Healthcare Collaborative
Kate Chenok, Pacific Business Group on Health
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
John E. Wennberg, The Dartmouth Institute
Do you know where the term “shared decision making” was first used…or when the first center dedicated to its research and implementation was opened? Our infographic “Shared Decision Making through the Decades” will take you on a historical journey through four decades of shared decision making to understand where it is today and what the future might hold.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Karen Sepucha, Massachusetts General Hospital
Dale Collins Vidal, The Dartmouth Institute for Health Policy & Clinical Practice
David Arterburn, MD, MPH, describes the Group Health experience in implementing decision aids as part of the shared decision making pathway. David also notes his publication in Health Affairs detailing the results of decision aid implementation.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Neil Korsen, MaineHealth
Larry Morrisey, Stillwater Medical Group
Charlie Brackett, Dartmouth-Hitchcock Medical Center
Grace Lin, Palo Alto Medical Foundation
Carmen Lewis, University of North Carolina
Leigh Simmons, Massachusetts General Hospital
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
Jeff Thompson, Washington State Health Care Authority
David Downs, Engaged Public
David Swieskowski, Mercy ACO Mercy Clinics, Inc.
Lisa Weiss, High Value Healthcare Collaborative
Kate Chenok, Pacific Business Group on Health
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
John E. Wennberg, The Dartmouth Institute
Do you know where the term “shared decision making” was first used…or when the first center dedicated to its research and implementation was opened? Our infographic “Shared Decision Making through the Decades” will take you on a historical journey through four decades of shared decision making to understand where it is today and what the future might hold.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Karen Sepucha, Massachusetts General Hospital
Dale Collins Vidal, The Dartmouth Institute for Health Policy & Clinical Practice
David Arterburn, MD, MPH, describes the Group Health experience in implementing decision aids as part of the shared decision making pathway. David also notes his publication in Health Affairs detailing the results of decision aid implementation.
Presented in:
Pre-Conference Workshop on Communication Skills in Management of Cancer Patients,
World Cancer Day Conference & Expo 2015
by National Cancer Society of Malaysia
Shared decision making involves doctors sharing information with patients about treatment options so patients can consider their options and make decisions together with their doctors. Decision aids like brochures and websites provide information to help patients make informed decisions by clarifying their values and preferences and guiding communication with doctors. Studies show decision aids increase patient knowledge and participation, align choices with values, and lower surgery rates without worse outcomes. Group Health implemented decision aid use for several conditions and is evaluating the impact on surgery rates, costs, and patient and provider experiences and identifying areas for improvement.
Shared decision making: Changing the relationship between doctor and patientMarkus Oei
This document discusses shared decision making between doctors and patients. It defines shared decision making as a process where doctors and patients make medical decisions together by considering evidence-based treatment options, their risks and benefits, and the patient's values and preferences. The document notes that while shared decision making improves health outcomes, many patients are not aware they have treatment choices and doctors do not always discuss patient preferences. It argues we need decision support tools, reliable patient information from various sources, and ways to effectively deliver this information to patients to facilitate shared decision making in clinical practice.
This document provides an introduction to shared decision making (SDM) and patient decision aids. It defines SDM as a process where patients are involved in making an informed, values-based choice between medically reasonable options. The document outlines the six steps to SDM and explains how patient decision aids can support the process by providing balanced information about conditions, treatments, and patient stories. It also reviews evidence that SDM increases patient knowledge and involvement in decisions, improves risk perception, and reduces decisional conflict and uncertainty.
Meg Bowen, implementation manager at the Informed Medical Decisions Foundation, provides a brief overview of the Foundation's shared decision making implementation history and introduces our three panelists for the webinar.
Safety is Personal: Partnering with Patients and Families for the Safest CareEngagingPatients
The work of NPSF"s Lucian Leape Institute's Roundtable on Consumer Engagement, "Safety Is Personal: Partnering with Patients and Families for the Safest Care" is a call to action for health leaders, clinicians, and policy makers to take the necessary steps to ensure patient and family engagement at all levels of health care.The report identifies specific action items for health leaders, clinicians, and policy makers to pursue in making patient and family engagement a core value in the provision of health. care.
The document discusses improving the quality of medical decisions through shared decision making. It finds that currently many patients are not well informed about their medical options and risks when consenting to procedures. Shared decision making models aim to have clinicians and patients work together to make informed and values-based choices. Research shows patient decision aids that provide balanced information on options can improve decision quality by increasing patient knowledge and engagement in the process.
Patients and their loved ones often hold critical knowledge that informs diagnosis. This toolkit from the Institute of Medicine offers patients, families and clinicians guidance on how they can collaborate to improve diagnosis.
Krames Patient Education is the only choice for enterprise-wide patient education. In this presentation, practices will learn who Krames Patient Education is and What we can do for you.
We will review Patient-Centered Care and Patient Education; The Case for a Patient Education Investment, The Krames Differencet; Return on Investment; and Krames Solutions.
At the end of the session patient/family champions as well as health authorities will leave armed with best practices, resources and ideas on how to open the door for patient/family engagement with health authorities and how to make the most of the time together.
The document outlines a plan by Henry Ford Health System to implement routine dementia screening for senior patients aged 70 and older using online cognitive and behavioral assessments, with positive screens receiving further evaluation, diagnosis if appropriate, treatment, and referral to social services for patient and caregiver support. The goal is to test this screening program in two primary care clinics over 6 months before evaluating outcomes and potential expansion to other primary care practices.
After hearing the perspectives of patients, providers and leaders from Indigenous communities on how they perceive safety and what solutions are/ can be implemented, we will leave the session with at least one practical idea for engaging all patients, families and/or the public in improving patient safety.
Evidence demonstrates that communication is one of the leading contributors to adverse events. Transitions of care epitomize this challenge.
WATCH ON DEMAND: https://goo.gl/M1ovsS
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
Failure to Rescue is ranked #2 in healthcare claims in Canada (HIROC, 2017) Additionally, Health Standards Organization (HSO) recently updated the critical care and inpatient services standards sets to include requirements supporting the recognition and response to clinical deterioration.
Full details: https://goo.gl/cfTUrm
At the end of the session patient/family champions as well as health authorities will understand different approaches to patient engagement in patient safety and quality committees (e.g. dealing with incident reporting, root cause analysis, developing policies and procedures) and how patient engagement impacted patient safety and quality outcomes. The participants and presenters are invited to present examples, tools, and leading practices so the participants will leave with at least one practical idea to implement.
This lecture discusses patient decision aids which are tools that help patients become involved in healthcare decisions by providing information on their options and clarifying personal values while complementing practitioner counseling. Patient decision aids can be used during or outside clinical encounters. Shared decision making is measured by evaluating the decision process quality and choice quality. There are standards for patient decision aids through organizations like IPDAS. Health information technology could help connect patients to decision aids and support shared decision making between patients and providers.
Patient, carer & public involvement in clinical guidelines: the NICE experienceGuíaSalud
Presentación de Victoria Thomas, Associate Director, Patient & Public Involvement Programme de NICE, sobre la participación de pacientes, ciudadanos y público en general en el desarrollo de guías de práctica clínica del NICE. Ponencia realizada en la Jornada Científica GuíaSalud 2010 "La participación de los pacientes en las Guías de Práctica Clínica".
Presented in:
Pre-Conference Workshop on Communication Skills in Management of Cancer Patients,
World Cancer Day Conference & Expo 2015
by National Cancer Society of Malaysia
Shared decision making involves doctors sharing information with patients about treatment options so patients can consider their options and make decisions together with their doctors. Decision aids like brochures and websites provide information to help patients make informed decisions by clarifying their values and preferences and guiding communication with doctors. Studies show decision aids increase patient knowledge and participation, align choices with values, and lower surgery rates without worse outcomes. Group Health implemented decision aid use for several conditions and is evaluating the impact on surgery rates, costs, and patient and provider experiences and identifying areas for improvement.
Shared decision making: Changing the relationship between doctor and patientMarkus Oei
This document discusses shared decision making between doctors and patients. It defines shared decision making as a process where doctors and patients make medical decisions together by considering evidence-based treatment options, their risks and benefits, and the patient's values and preferences. The document notes that while shared decision making improves health outcomes, many patients are not aware they have treatment choices and doctors do not always discuss patient preferences. It argues we need decision support tools, reliable patient information from various sources, and ways to effectively deliver this information to patients to facilitate shared decision making in clinical practice.
This document provides an introduction to shared decision making (SDM) and patient decision aids. It defines SDM as a process where patients are involved in making an informed, values-based choice between medically reasonable options. The document outlines the six steps to SDM and explains how patient decision aids can support the process by providing balanced information about conditions, treatments, and patient stories. It also reviews evidence that SDM increases patient knowledge and involvement in decisions, improves risk perception, and reduces decisional conflict and uncertainty.
Meg Bowen, implementation manager at the Informed Medical Decisions Foundation, provides a brief overview of the Foundation's shared decision making implementation history and introduces our three panelists for the webinar.
Safety is Personal: Partnering with Patients and Families for the Safest CareEngagingPatients
The work of NPSF"s Lucian Leape Institute's Roundtable on Consumer Engagement, "Safety Is Personal: Partnering with Patients and Families for the Safest Care" is a call to action for health leaders, clinicians, and policy makers to take the necessary steps to ensure patient and family engagement at all levels of health care.The report identifies specific action items for health leaders, clinicians, and policy makers to pursue in making patient and family engagement a core value in the provision of health. care.
The document discusses improving the quality of medical decisions through shared decision making. It finds that currently many patients are not well informed about their medical options and risks when consenting to procedures. Shared decision making models aim to have clinicians and patients work together to make informed and values-based choices. Research shows patient decision aids that provide balanced information on options can improve decision quality by increasing patient knowledge and engagement in the process.
Patients and their loved ones often hold critical knowledge that informs diagnosis. This toolkit from the Institute of Medicine offers patients, families and clinicians guidance on how they can collaborate to improve diagnosis.
Krames Patient Education is the only choice for enterprise-wide patient education. In this presentation, practices will learn who Krames Patient Education is and What we can do for you.
We will review Patient-Centered Care and Patient Education; The Case for a Patient Education Investment, The Krames Differencet; Return on Investment; and Krames Solutions.
At the end of the session patient/family champions as well as health authorities will leave armed with best practices, resources and ideas on how to open the door for patient/family engagement with health authorities and how to make the most of the time together.
The document outlines a plan by Henry Ford Health System to implement routine dementia screening for senior patients aged 70 and older using online cognitive and behavioral assessments, with positive screens receiving further evaluation, diagnosis if appropriate, treatment, and referral to social services for patient and caregiver support. The goal is to test this screening program in two primary care clinics over 6 months before evaluating outcomes and potential expansion to other primary care practices.
After hearing the perspectives of patients, providers and leaders from Indigenous communities on how they perceive safety and what solutions are/ can be implemented, we will leave the session with at least one practical idea for engaging all patients, families and/or the public in improving patient safety.
Evidence demonstrates that communication is one of the leading contributors to adverse events. Transitions of care epitomize this challenge.
WATCH ON DEMAND: https://goo.gl/M1ovsS
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
Failure to Rescue is ranked #2 in healthcare claims in Canada (HIROC, 2017) Additionally, Health Standards Organization (HSO) recently updated the critical care and inpatient services standards sets to include requirements supporting the recognition and response to clinical deterioration.
Full details: https://goo.gl/cfTUrm
At the end of the session patient/family champions as well as health authorities will understand different approaches to patient engagement in patient safety and quality committees (e.g. dealing with incident reporting, root cause analysis, developing policies and procedures) and how patient engagement impacted patient safety and quality outcomes. The participants and presenters are invited to present examples, tools, and leading practices so the participants will leave with at least one practical idea to implement.
This lecture discusses patient decision aids which are tools that help patients become involved in healthcare decisions by providing information on their options and clarifying personal values while complementing practitioner counseling. Patient decision aids can be used during or outside clinical encounters. Shared decision making is measured by evaluating the decision process quality and choice quality. There are standards for patient decision aids through organizations like IPDAS. Health information technology could help connect patients to decision aids and support shared decision making between patients and providers.
Patient, carer & public involvement in clinical guidelines: the NICE experienceGuíaSalud
Presentación de Victoria Thomas, Associate Director, Patient & Public Involvement Programme de NICE, sobre la participación de pacientes, ciudadanos y público en general en el desarrollo de guías de práctica clínica del NICE. Ponencia realizada en la Jornada Científica GuíaSalud 2010 "La participación de los pacientes en las Guías de Práctica Clínica".
Decision making in community health nursingNisha Yadav
Decision-making is a core part of community health nursing. There are several types of decision-making including programmed decision-making for routine issues and non-programmed decision-making for unique issues. The decision-making process involves defining the problem, gathering facts, evaluating alternatives, implementing a choice, and following up. Three frameworks are outlined for ethical decision-making - the DECIDE model, a six step framework, and considering values of self-determination, well-being, and equity.
How to make care and support planning a two-way dynamic - presentation from webinar held on 1 October 2014
This relates to the first NHS IQ Long Term Conditions Improvement Programmes Wednesday Lunch & Learn Webinar Series. How to make care and support planning a 2 way dynamic hosted by Dr Alan Nye & Brook Howells from AQuA. This webinar discussed how to encourage patients, carers and the public to work alongside (in equal partnership) with clinicians and managers
1) Quality and safety in healthcare aims to minimize risks of harm to patients through effective systems and individual performance. Common medical errors include medication errors, wrong-site surgeries, and misdiagnoses.
2) QSEN seeks to prepare nurses with competencies in patient-centered care, teamwork, evidence-based practice, quality improvement, safety, and informatics to continuously improve healthcare quality and safety.
3) Providing high-quality, patient-centered care requires effective communication, collaboration, and shared decision-making among healthcare team members and with patients and their families.
This document discusses shared decision making initiatives in England. It describes 3 key programs - the Health Foundation's MAGIC program which developed decision aids and trained clinicians, the NHS Right Care program which created 38 online decision aids for conditions like cancer and joint replacements, and Bupa UK's treatment options service which engaged over 10,000 members through health coaching. It outlines successes of each program like cost savings, high patient satisfaction, and policy influence, but also challenges of sustainability, embedding in healthcare systems, and overcoming cultural barriers. The document advocates for further adoption of shared decision making in the NHS, expanding decision aid availability, and building awareness among patients.
As new payment models emerge that emphasize value over volume, providers are being compelled to look more closely at how to motivate patients—especially those with multiple chronic conditions—to actively manage their care, make better decisions and change behaviors. This editorial webinar will explore the relationships between engagement and improved health outcomes, greater patient satisfaction and better resource utilization. Our panel of experts will share proven strategies for building patients' confidence, disseminating self-management tools and making the best use of your care team.
20131210 Electronic Health Records - Is the NHS ready? What about patientsamirhannan
On 12th December 2013, Dr Hannan (GP / family physician) along with Marilyn Gollom (patient) presented this talk to Health 2.0 Manchester. You can watch the talk by going to http://www.htmc.co.uk/pages/pv.asp?p=htmc0519.
The Surgical Initiative concluded on March 31, 2014; the first system Hoshin to “graduate” to everyday work. Join us for an interactive discussion of the lessons learned over four years of transformational change.
The document discusses the MS Decisions website, which was developed to help people with multiple sclerosis make informed choices about disease-modifying treatments. It provides an overview of how the website was developed and managed over time by various organizations, with input from health professionals, people with MS, and pharmaceutical companies. Survey feedback indicates that the website is well-received and helpful to both people with MS and healthcare providers in understanding treatment options and making decisions. The document also outlines plans to continue improving and updating the site.
On 12th December 2013, Dr Hannan (GP / family physician) along with Marilyn Gollom (patient) presented this talk to Health 2.0 Manchester. You can watch the talk by going to http://www.htmc.co.uk/pages/pv.asp?p=htmc0519.
Angela Coulter: Getting the best value for patientsThe King's Fund
Dr Angela Coulter, Director of Global Initiatives, Foundation for Informed Medical Decision Making, spoke at The King's Fund's 'Reducing unwarranted variations in health care' conference, giving her expert opinion on how to give the best value for patients: with the right intervention, in the right place, at the right time with the right level of involvement.
Patient Focus within Healthcare CongressesPYA, P.C.
As the doctor-patient relationship evolves, the terms “patient activation and engagement” are cropping up more frequently in healthcare circles, including the International Pharmaceutical Congress Advisory Association (IPCAA) Conference in Philadelphia. PYA Principal Kent Bottles, MD, who is also chief medical officer of PYA Analytics, presented “Patient Focus within Healthcare Congresses.”
The document discusses clinical decision making for nurses and healthcare professionals. It covers the principles of clinical decision making including pattern recognition, critical thinking, communication, evidence-based approaches, teamwork, reflection, and shared decision making. The decision making process involves gathering information, making judgements, deciding on a course of action, and evaluating outcomes. Shared decision making emphasizes involving patients in the decision making process from information gathering to agreeing on a treatment plan.
Advance Care Planning & Advance Healthcare Directives with People with DementiaIrish Hospice Foundation
1. The document provides guidance on advance care planning and advance healthcare directives for people with dementia, their families, and healthcare professionals.
2. It outlines four key considerations for good practice: understanding dementia, recognizing patient rights, understanding advance care planning, and being familiar with the Assisted Decision Making Act regarding capacity and advance directives.
3. The guidance stresses the presumption of capacity, engaging the patient, and considering previously expressed preferences when making decisions for those lacking capacity. It also describes what can be included in an advance healthcare directive.
Utilización de la evidencia cualitativa para mejorar la inclusión de las pref...GuíaSalud
Tercera intervención de la Mesa 1 de la Jornada científica GuíaSalud 2017: La implicación de pacientes en el desarrollo de GPC. Una estrategia necesaria para mejorar la toma de decisiones. Simon Lewin
Shared Decision Making in health (Decisions Compartides) is a project of the Catalan Health Ministry of the Generalitat de Catalunya. Physicians and patients are involved in shared medical decisions. Both parties share information (evidence based information about treatment options, cons and pros, patient preferences and values) and an agreement is reached on the treatment to implement.
Ethics and Learning Health Care: an overview of the differences between what is considered research and what is considered clinical care, and an introduction to the ethical issues that arise from this boundary being blurred.
The nursing process is a framework that organizes nursing care through five steps: assessment, nursing diagnosis, planning, implementation, and evaluation. It provides an orderly and systematic method for planning and delivering nursing care centered around the client. The assessment step involves comprehensively gathering both subjective and objective data on the client's health, needs, and situation through various sources like interviews, examinations, and records.
Semelhante a Implementation of Shared Decision Making: Measuring Success (20)
25 Champions of Shared Decision Making, selected by the staff of the Informed Medical Decisions Foundation. This is not a top 25 list, merely a list of 25 individuals the staff wanted to recognize.
This document summarizes a medical editors meeting about treatment options for peripheral artery disease (PAD). It discusses the development of an educational program about PAD for patients. The program aims to help patients make informed decisions about improving walking ability and reducing cardiovascular risk. Challenges in developing the program included communicating treatment benefits, comparing varied efficacy data, and addressing uninsurance coverage for supervised exercise. The document outlines strategies for addressing these challenges.
This document summarizes the results of a national survey of medical decisions. It found that 77% of Americans aged 40+ discussed at least one medical decision in the past two years. The most common decisions discussed were starting or stopping medication (52%) and discussing screening tests (59%). Knowledge about medical conditions was low, ranging from 20% to 84% correct depending on the condition. Discussion of pros and cons varied, from 6% to 84% depending on the decision. The decision process score, which measures how informed and collaborative the decision process was, ranged from 1.5 to 3.2 out of 5 depending on the decision. In the end, patients had surgery 42% of the time, took medication 79% of the
The document discusses using patient interviews to support patient decisions in medical care. It notes that patient interviews were initially used because patients should hear other patients' voices and be exposed to different choices. However, patient interviews are now being reexamined because they are relatively expensive and questions have been raised about their need as media moves to more web and mobile formats. While some argue patient interviews can be biasing, the organization finds them engaging and believes they can help patients understand options when used properly and not inherently bias decisions. More research is still needed on how different uses of interviews impact decision making.
The document summarizes the activities of the Content Development Team at the Foundation from 2012-2013, including program updates, new programs developed, and collaborations. Some of the key projects discussed include adapting decision aids for use in Australia, collaborating with outside organizations on grants and standards, and new partnerships to create medication decision aids with the American College of Cardiology.
Narratives play several roles in decision aids such as engaging patients, informing them, modeling behaviors, helping patients weigh trade-offs and clarify values, but they also raise some concerns. While narratives can make information more memorable, they risk focusing on outliers and distracting from facts. The evidence on whether narratives influence decisions is mixed, though they certainly have power. The document advocates using curated patient narratives in addition to factual information to complement rather than replace facts, mitigate potential biases, and represent both common and uncommon patient viewpoints and experiences.
This study examined factors that predict whether patients with depression choose to start or continue medication treatment, or discuss non-medication treatment options with their healthcare provider. The study found that patients with worse health status or who prioritize quick relief were more likely to take medication. Patients concerned about medication side effects or costs were less likely to take them. Minority patients and those without health insurance were more likely to discuss alternative options or less likely to take medication, possibly due to stigma or lack of access. Overall, patients appeared informed about their treatment decisions.
This study surveyed U.S. adults aged 40 and older about their medical decision making regarding cancer screening tests and medications for common conditions. It found that decision processes were generally poor across age groups. While knowledge about treatments was higher for medications than screening, all groups valued potential benefits highly. The oldest group (75+) reported less discomfort with some cancer screenings and less importance on costs or side effects of medications. The study concludes there is opportunity to better educate elderly patients and their doctors about estimated benefits, competing risks when considering screenings or adding medications.
Diana Stilwell, MPH, chief production officer at the Informed Medical Decisions Foundation, walks through the role of narratives in decision aids and how the available evidence relates to the Foundation approach.
This presentation was part of a Shared Decision Making Month webinar -- The Power of Narratives: How They Shape the Way Patients Make Medical Decisions.
Jack Fowler, PhD, senior scientific advisor at the Informed Medical Decisions Foundation provides an overview of the Foundation's path to developing decision aids that included patient narratives.
This presentation was part of a Shared Decision Making Month webinar -- The Power of Narratives: How They Shape the Way Patients Make Medical Decisions.
Victoria Shaffer, PhD, describes the the pros and cons of narratives and then explains her work to develop a system of classification for narratives as part of the solution. Victoria provides an overview of the narrative taxonomies she and her colleague have developed.
This presentation was part of a Shared Decision Making Month webinar -- The Power of Narratives: How They Shape the Way Patients Make Medical Decisions.
Karen Sepucha, PhD, describes what a good decision is, how we measure decision quality and how the decision quality instrument might be used.
This presentation was part of a Shared Decision Making Month webinar -- What Makes a Good Medical Decision? Defining and Implementing Decision Quality Measures.
Doctors need to ensure patients are informed, involved in the decision making process, and that the final decision aligns with what is most important to the patient. Measuring decision quality helps evaluate support strategies, assess provider support of patients facing medical decisions, and ensures informed patient input is included. The key elements of measuring decision quality are that patients know key facts, doctors meaningfully involve patients, and the decision aligns with patient priorities.
David Wennberg, MD, MPH, describes a recent randomized trial he was involved with that studied the potential of shared decision making to reduce costs among preference-sensitive conditions. David also explains the vision of the 20-member High Value Healthcare Collaborative.
This presentation was part of the Shared Decision Making Month webinar "Turning Shared Decision Making Policy into a Reality."
Ben Moulton, JD, MPH, provides an overview of the shared decision making policy landscape.
This presentation was part of a Shared Decision Making Month webinar -- Turning Shared Decision Making Policy into a Reality: Can We Really Improve the Quality of Care While Reducing the Costs.
Kristen Oganowski, CD(DONA) shares her experience as a parent/patient doula advocate.
This presentation was part of a Shared Decision Making Month webinar -- Maternity Care and Shared Decision Making: Improving Care for Mothers and Babies.
Kate Chenok, a director at Pacific Business Group on Health, provides the purchaser perspective on shared decision making and maternity care.
This presentation was part of a Shared Decision Making Month webinar -- Maternity Care and Shared Decision Making: Improving Care for Mothers and Babies.
Maureen Corry, executive director of Childbirth Connection, provides an overview of the state of shared decision making and maternity care.
This presentation was part of a Shared Decision Making Month webinar -- Maternity Care and Shared Decision Making: Improving Care for Mothers and Babies.
Jeff Belkora, associate professor at the University of California, San Franscisco, shares UCSF Breast Care Center's unique approach to support shared decision making: using student health coaches.
This presentation was part of a Shared Decision Making Month webinar -- Shared Decision Making in the Real World: Stories from the Frontline.
Nancy Rothman, a nursing professor at Temple University, describes the "Better Decisions Together" project aimed at engaging the chronically homeless and public housing residents in their health care decisions.
This presentation was part of a Shared Decision Making Month webinar -- Shared Decision Making in the Real World: Stories from the Frontline.
Mais de Informed Medical Decisions Foundation (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
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Implementation of Shared Decision Making: Measuring Success
1. I m p l e m e n t a t i o n o f S h a r e d D e c i s i o n M a k i n g : M e a s u r i n g S u c c e s s
Aligning Incentives for Patient
Engagement
May 24, 2013
2. Implementing Shared Decision Making
in Primary Care
_____________________________________________
Barriers, Solutions, and Measurement
Mark W. Friedberg, MD, MPP1
Kristin Van Busum, MPA1
Richard Wexler, MD2
Megan Bowen2
Eric C. Schneider, MD, MSc1
1RAND Corporation
2Informed Medical Decisions Foundation
Sponsor: Informed Medical Decisions Foundation
3. We Evaluated a Demonstration of Shared
Decision Making
3
• 8 sites containing 34 primary care clinics
- Selected for prior quality improvement experience
- Some without prior decision aid experience
• July 2009-June 2012
• Sponsored by the Informed Medical Decisions
Foundation
- Free decision aids
- Technical assistance
- Learning collaborative
• Qualitative evaluation at 18 months
4. Objectives of Evaluation
1. Identify barriers and facilitators to
implementing shared decision
making in primary care settings
2. Develop options for near-term
quantitative evaluation
4
5. Semi-Structured Interviews
5
• 23 leaders and clinicians from all demonstration
sites
• 10 patients from 1 site who had each received a
decision aid during the demonstration
• Protocol investigated facilitators and barriers to:
-Engaging clinicians
-Integrating decision aids into key operational tasks
• Interview responses analyzed inductively for
recurrent themes
6. Key Steps of Shared Decision Making Based
on Decision Aids
Decision
opportunity
identification
Opportunity
recognized
DA matched
to
opportunity
Decision aid
use
DA
distributed
Patient uses
DA
Post-DA
conversation
Clarify
medical
information
Elicit values
and
preferences
Make shared
decision
Health care
delivery
Care
consistent
with final
shared
decision
7. Barriers to Shared Decision Making
7
• Overworked physicians do not recognize decision
opportunities and distribute decision aids reliably
“Patients come in and doctors are seeing them for four or
five different problems. And then they have to remember if
there is a decision aid for each particular decision.”
“We hear physicians say…I seem to be the problem here,
how do I get myself out of the loop so we can get [the
decision aids] to people that need to get them?”
“In the real world . . I’m not sure we can expect the
physicians to identify patients.”
8. Barriers to Shared Decision Making
8
• Overworked physicians do not recognize decision
opportunities and distribute decision aids reliably
• Insufficient provider training
-Recognizing decision opportunities and having post-decision
aid conversations are skills providers must learn
“Physicians felt that they were already doing shared
decision making [before introducing decision aids].”
“You really have to pay attention to the clinicians in
this equation. You can’t just ask them to do something
and assume that they’ll know what you mean…we
under-attended the training of our clinicians.”
9. Barriers to Shared Decision Making
9
• Overworked physicians do not recognize decision
opportunities and distribute decision aids reliably
• Insufficient provider training
• Inadequate clinical information systems
-Not able to track the full sequence of steps involved in shared
decision making
-Not able to integrate with decision aids
“All of the information from the [decision aid
questionnaires] is off the chart. There is documentation
that a decision aid was given…but anything from the
surveys is kept completely separate.”
10. Solutions Sites Employed
10
• Automatic triggers for decision aid distribution
-Trigger on patient age and gender (for screening)
-Trigger on specialist referrals (for surgical procedures)
Relative greater focus of specialist visits may facilitate
more reliable performance of post-decision aid
conversation
• Engage team members other than physicians
-Example: “decision coach” to introduce the decision aid
Patient: “When you’re with the doctor, you don’t get a
chance to ask a lot of questions. …A nurse I had
never met [before] came in and introduced me to [the
decision aid]. She had a CD and a book about the
surgery. …Of course I was interested in that.”
11. Measuring the Successfulness of
Implementing Shared Decision Making
11
• Process measures should capture all steps of
shared decision making
- “All-or-none” measures may be appropriate
12. Vulnerability in Later Steps of
Shared Decision Making
Decision
opportunity
identification
Opportunity
recognized
DA matched
to
opportunity
Decision aid
use
DA
distributed
Patient uses
DA
Post-DA
conversation
Clarify
medical
information
Elicit values
and
preferences
Make shared
decision
Health care
delivery
Care
consistent
with final
shared
decision
Rate-limiting steps = targets for measurement
13. Measuring the Successfulness of
Implementing Shared Decision Making
13
• Process measures should capture all steps of
shared decision making
- “All-or-none” measures may be appropriate
• Measures of decision quality
- In the end, was care consistent with the patient’s values
and preferences?
14. Measuring the Successfulness of
Implementing Shared Decision Making
14
• Process measures should capture all steps of
shared decision making
- “All-or-none” measures may be appropriate
• Measures of decision quality
- In the end, was care consistent with the patient’s values
and preferences?
• Indirect measures of shared decision making
performance
- In theory, shared decision making should produce
variability that is driven entirely by patients, not providers
- If each provider in an organization has a PSA screening
rate of 100% or 0%, the organization is unlikely to have
implemented shared decision making successfully
15. Implications
15
• Achieving shared decision making will require “new
operating systems” for primary care practices
- Major investments in developing and improving
educational, operational, and informatics systems
- Payment reform may be necessary
• Key issue for policy makers: How high to set the bar
for deciding what counts as “engagement” in
shared decision making
- Lower bar: count or rate of decision aid distribution
- Higher bar: all-or-none process measures including all
steps of shared decision making
17. Implementing Patient Decision Aids for
Increased Patient Engagement and
Reduced Costs
David Arterburn MD, MPH
Group Health Research Institute
18. Financial disclosure
• I have received research funding and salary support from the
Informed Medical Decisions Foundation
• I serve as a Medical Editor for the Informed Medical Decisions
Foundation in the area of bariatric surgery
19. What is Group Health?
• Group Health is a consumer-governed, non-profit
health system that integrates care and coverage for
over 600,000 residents of Washington state and
Northern Idaho (1 in 10 Washington residents)
• Two-thirds of our members get most of their care
within our Integrated Group Practice from salaried
Group Health providers
20. Outline
1. What was Group Health’s pathway to large-scale implementation
of Shared Decision Making?
2. What infrastructure elements did Group Health put in place to
support Shared Decision Making?
3. What did Group Health leadership do to create a culture of
expectation around Shared Decision Making and begin to build
competencies among providers?
4. What outcomes have we observed?
5. What steps are we taking now to optimize Shared Decision
Making at Group Health?
23. Shared decision making – the highest legal
standard in Washington state
• 2007 Washington state legislation:
– Recognized the use of shared decision making
along with high-quality patient decision aids as the
highest standard of informed consent
– Mandated, but did not fund, the state Health Care
Authority (HCA) to implement shared decision
making demonstration projects
• 2012 Washington state legislation:
– Authorized the WA state HCA to certify high-quality
decision aids
26. Twelve preference-sensitive conditions
• Orthopedic Surgery
– Hip Osteoarthritis
– Knee Osteoarthritis
• Cardiology
– Coronary Artery Disease
• Urology
– Benign Prostatic Hyperplasia
– Prostate Cancer
• Women’s Health
– Uterine Fibroids
– Abnormal Uterine Bleeding
• Breast Cancer – General Surgery
– Early Stage Breast Cancer
– Breast Reconstruction
– Ductal Carcinoma In Situ
• Neurosurgery
– Spinal Stenosis
– Herniated Disc
29. EpicCare “smart phrases” for easier documenting of
shared decision making conversations
• Before Decision Aid Viewing
“The patient and I engaged in a shared decision making conversation.
I recommended that the patient review a Health Dialog decision aid and
make an appointment with me to finalize a treatment plan.”
• After Decision Aid Viewing
“The patient and I engaged in a shared decision making conversation.
The patient had previously reviewed the Health Dialog patient decision
aid. We discussed the content of the decision aid, clarified the patient’s
treatment preferences, and I answered the patient’s questions. We
agreed to the following treatment/services(s): *** and ***. The patient
signed the applicable consent form.”
30. Appropriate staffing for implementation and
ongoing process improvement
30
Project managers with experience implementing
practice changes at Group Health were hired to
carry out this work
31. Creating a culture of expectation
and building competencies for
providers
32. But I already DO shared decision-making with
my patients…
Of course it is totally
up to you, but if it was
me, I’d choose to have
the surgery.
33. Setting the tone for competency in shared
decision making
“Nice to do
if you have
the time and
inclination.”
“No patient
should undergo
a preference
sensitive procedure
without documented
evidence that they
got all the information
they needed and then
had a conversation with
their provider in which
their preferences were
documented before they
made their decision.”
Cultural spectrum
GH leaders want to
push providers right
over here!
34. Key culture change steps
• Required all providers to watch the relevant decision aids
• ½-day CME with outside experts trained 90% of our specialty providers
and surgeons
• Monthly feedback to leaders and providers
– Volume of decision aids ordered
– Volume of surgical procedures and total costs of surgical procedures
– Number and percent of surgical patients in each specialty who had
surgery without receiving a decision aid
• Patient satisfaction data related to decision aid use
39. Process measure – “defect measure” shows
fewer missed opportunities for DA delivery
40.
41.
42.
43. Comparison of mean costs in 6 months
after index date, control vs. intervention
Hip Osteoarthritis Cohorts
Control
N=968
Intervention
N=820
Costs (2009 dollars)
Total, Mean $16,557 $13,489
Inpatient $7,793 $5,774
Outpatient $8,764 $7,715
Primary Care $548 $568
Pharmacy $4,894 $4,091
Specialty Care $2,497 $1,868
Orthopedic Surgery $790 $629
Knee Osteoarthritis Cohorts
Control
N=4217
Intervention
N=3510
$10,040 $8,041
$3,512 $2,475
$6,528 $5,565
$597 $532
$3,219 $2,591
$1,460 $951
$773 $694
45. Adding new decision aids
• Already implemented:
– Acute Low Back Pain
– Chronic Low Back Pain
– Weight Loss Surgery
• Planned:
– End of Life Care
– End Stage Renal Disease Treatment Options
– Maternity Suite (Suspected Macrosomia, Elective Induction,
and Vaginal Birth After Cesearian)
46. Moving “upstream” into Primary Care
Four primary care clinics began Jan 2013 (system-wide by Dec 2013)
– Two in Spokane; One each in Olympia and north Seattle
Any patient diagnosed with a condition where we have a decision aid
- Primary care provider lets know that there is a decision aid that they want
them to watch to understand the risk/benefits of treatment choices
- Ask patient their preference for viewing video: Online or having DVD mailed
to them.
- Let patient know you’ll have a follow up conversation once they’ve viewed it
Follow up conversation
– Have discussion via email or by phone
– Review their knowledge, ask for questions/concerns, ask for their preference
regarding treatment choice; consider need for referral
48. Implementing Feed Forward Questionnaires
• Implementing standardized measures of patient symptoms, prior
treatment, knowledge, values, and treatment preferences
• Patients will be prompted to complete the questionnaires online
after viewing a decision aid and before their next visit
• Questionnaire results summary will be imported into Epic as either
an “encounter”, a “flowsheet”, or both
• Provider can review results at the point of care
52. Acknowledgements
• Funding
• Informed Medical Decisions
Foundation
• The Commonwealth Fund
• Health Dialog
• Group Health Foundation
• GH Physician Leadership
• Michael Soman Marc Mora
• Paul Sherman Chris Cable
• Dave McCulloch Matt Handley
• Charlie Jung Nate Green
• Jane Dimer Mark Lowe
• JC Leveque Gerald Kent
• Paul Fletcher Tom Schaff
• Rick Shepard
• Public Policy
• Karen Merrikin
• GH Implementation
• Tiffany Nelson Stan Wanezek
• Charity McCollum Jan Collins
• Andrea Lloyd Scott Birkhead
• Colby Voorhees
• GH Research Institute
• Emily Westbrook
• Rob Wellman Carolyn Rutter
• Tyler Ross Darren Malais
• Clarissa Hsu Sylvia Hoffmeyer
• David Liss Jane Anau
• External Advisors
• Jack Wennberg Michael Barry
• Doug Conrad Cindy Watts
• David Veroff Richard Wexler
• Kate Clay Leah Hole-Curry
53.
54. Implementation of Shared Decision
Making: Measuring Success
Results of a large scale randomized trial
testing two levels of shared decision making
support
55. Background
Important deficits in patient
participation in decisions about
their care.
Shared Decision Making improves
care and patient experiences
Conducted a randomized trial
comparing two levels of telephonic
support for people with conditions
that involve multiple treatment
options
56. Previously published study
Largest study of population
care management to date
Collaboration between Health Dialog
and two clients
Randomized study of 174,120
individuals
Compared medical costs and
utilization of two different care
support strategies
Overall results:
Total costs reduced by over 3.6%
Total population admissions reduced
by 10.1%
57. Structured stratified random sampling
Predictive models and real time data were used to assess the likelihood of
using or needing health care services
Rank-order lists of individuals likely to have support needs were used to
generate:
Outbound mail
Interactive voice response calls
Calls by health coaches
Study Design
58. EnhancedSupportUsualSupportEnhancedSupport
Difference driven by who was targeted for engagement
Enhanced support versus
usual support
High
Risk
Low
Risk
Health Continuum
Chronic
Preference
Sensitive
Care
Other
High Risk Healthy
Focus on Preference
Sensitive Conditions
N = 60,185
59. Based on original randomized trial
• Baseline data on the 60,185 identified as potential candidates for
Shared Decision Making
Preference Sensitive Focus
Usual Support Enhanced Support
Number 30,240 29,945
Costs
Total medical costs (PMPM) $371.92 $371.73
Inpatient costs (PMPM) $106.77 $106.05
Resource Use
Inpatient admissions (per 1,000/yr) 131 129
Emergency department (per 1,000/yr) 377 379
Surgeries for PSC (per 1,000/yr) 32 30
Advanced imaging studies (per 1,000/yr) 372 382
Standard imaging studies (per 1,000/yr) 1,396 1,394
60. Outreach activity
0
200
400
600
800
1000
Any PSC Heart ConditionBenign Uterine CondBenign Prostatic Cond Hip Pain Knee Pain Back Pain
Coach Contacts Usual
Enhanced
0
10
20
30
40
50
60
70
Any PSC Heart ConditionBenign Uterine CondBenign Prostatic Cond Hip Pain Knee Pain Back Pain
Videos Sent
Usual
Enhanced
61. Cost and utilization
Usual
Support
Enhanced
Support
Relative
diff (%)
Absolute
diff
Number 30,240 29,945
Costs
Total medical costs (PMPM) $436.05 $412.78 (5.3%) ($23.27)
Inpatient costs (PMPM) $132.73 $116.20 (12.5%) ($16.53)
Outpatient costs (PMPM) $96.91 $92.49 (4.6%) ($4.42)
Resource Use (per 1,000/yr)
Inpatient admissions (per 1,000/yr) 155 135 (12.5%) (20)
Emergency department (per 1,000/yr) 409 399 (2.6%) (10)
Surgeries for PSC (per 1,000/yr) 32 29 (9.9%) (3)
Advanced imaging studies (per
1,000/yr)
400 393 (1.9%) (7)
Standard imaging studies (per 1,000/yr) 1,488 1,458 (2.0%) (30)
62. Implications
Lower overall costs speaks to the power of SDM well
beyond surgical decisions
When physician adoption comes slowly, independent
telephonic support model can get the process started
and can be effective
Notas do Editor
Patient satisfaction and overall rating of decision aid videos:(from 2,156 respondents)Helped me understand my treatment choices:25% Excellent48% Very good23% Good
Patient satisfaction and overall rating of decision aid videos:(from 2,139 respondents)Helped me prepare to talk with my provider:24% Excellent47% Very good24% Good