Ten years, forty decision aids, and thousands of patient uses: Shared decision making at massachusetts general hospital

Health Affairs

Volumn 35, Issue 4, 2016, Pages 630-636

  Sepucha, Karen R ^a   Simmons, Leigh H ^a   Barry, Michael J ^a   Edgman Levitan, Susan ^a   Licurse, Adam M ^b,c   Chaguturu, Sreekanth K ^a,d  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b Partners Health Care   (United States)

^c BRIGHAM AND WOMEN S HOSPITAL   (United States)

^d HARVARD MEDICAL SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; CONSENSUS DEVELOPMENT; CONVERSATION; DECISION MAKING; DOCTOR PATIENT RELATION; GENERAL HOSPITAL; HEALTH CARE PERSONNEL; HUMAN; MAJOR CLINICAL STUDY; MASSACHUSETTS; PRIMARY MEDICAL CARE; DECISION SUPPORT SYSTEM; EVALUATION STUDY; FEMALE; HEALTH CARE QUALITY; MALE; MIDDLE AGED; ORGANIZATION AND MANAGEMENT; PATIENT CARE; PATIENT PARTICIPATION; PRIMARY HEALTH CARE; STATISTICS AND NUMERICAL DATA; TIME FACTOR;

ADULT; DECISION MAKING; DECISION SUPPORT TECHNIQUES; EVALUATION STUDIES AS TOPIC; FEMALE; HOSPITALS, GENERAL; HUMANS; MALE; MASSACHUSETTS; MIDDLE AGED; PATIENT CARE TEAM; PATIENT PARTICIPATION; PRIMARY HEALTH CARE; QUALITY ASSURANCE, HEALTH CARE; TIME FACTORS;

EID: 84964977632     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2015.1376     Document Type: Article

References (19)

1. Sepucha K, Mulley AG Jr. A perspective on the patient's role in treatment decisions. Med Care Res Rev. 2009;66(1 Suppl):53S-74S.
2. Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49(5): 651-61.
3. Coulter A, Cleary PD. Patients' experiences with hospital care in five countries. Health Aff (Millwood). 2001;20(3): 244-52.
4. Fagerlin A, Sepucha KR, Couper MP, Levin CA, Singer E, Zikmund-Fisher BJ. Patients' knowledge about 9 common health conditions: the DECISIONS survey. Med Decis Making. 2010;30(5 Suppl):35S-52S.
5. Zikmund-Fisher BJ, Couper MP, Singer E, Ubel PA, Ziniel S, Fowler FJ Jr, et al. Deficits and variations in patients' experience with making 9 common medical decisions: the DECISIONS survey. Med Decis Making. 2010;30(5 Suppl):85S-95S.
6. Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014;1: CD001431.
7. For example, the QualityPath program established by the Alliance requires the adoption of shared decision making and the use of patient decision aids for providers seeking recognition. Alliance. What is QualityPath®? [Internet]. Madison (WI): Alliance; [cited 2016 Feb 18]. Available from: http://www.the-alliance.org/qualitypath/.
8. Barry MJ, Fowler FJ Jr, Mulley AG Jr, Henderson JV Jr, Wennberg JE. Patient reactions to a program designed to facilitate patient participation in treatment decisions for benign prostatic hyperplasia. Med Care. 1995;33(8): 771-82.
9. Studies have documented that physicians are more willing to use decision aids once they have had a chance to review them. See Note 10 and Graham ID, Logan J, O'Connor A, Weeks KE, Aaron S, Cranney A, et al. A qualitative study of physicians' perceptions of three decision aids. Patient Educ Couns. 2003;50(3): 279-83.
10. Feibelmann S, Yang TS, Uzogara EE, Sepucha K. What does it take to have sustained use of decision aids? A programme evaluation for the Breast Cancer Initiative. Health Expect. 2011;14(Suppl 1):85-95.
11. A systematic review has also found that providers' motivation, perception of positive impact on clinical process, and perception of positive impact on patient outcomes are predictors of the use of patient decision aids. See Gravel K, Légaré F, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions. Implement Sci. 2006;1: 16.
12. Simmons L, Sepucha K. Orientation and education: steps needed to get clinicians to order patient decision support. In: Elwyn G, Grande SW, Gittel JH, Godfrey MM, Vidal DC, editors. Are we there yet? Case studies of implementing decision support for patients. Hanover (NH): Dartmouth Institute for Health Policy and Clinical Practice;2013. p. 67-76.
13. The statistical process control chart is a commonly used method to evaluate changes over time, and a grouping of seven data points above or below the mean indicate a significant change in the process. Langley GJ, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. The improvement guide: a practical approach to enhancing organizational performance. 2nd ed. San Francisco (CA): Jossey-Bass, 2009.
14. Simmons L, Leavitt L, Sepucha K. Letting patients decide: a novel strategy for increasing use of patient decision aids in primary care. In: Elwyn G, Edwards A, Thompson R, editors. Shared decision making in health care: achieving evidence-based patient choice. 3rd ed. Oxford: Oxford University Press; forthcoming.
15. Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When patient activation levels change, health outcomes and costs change, too. Health Aff (Millwood). 2015;34(3): 431-7.
16. Arterburn D, Wellman R, Westbrook E, Rutter C, Ross T, McCulloch D, et al. Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs. Health Aff (Millwood). 2012;31(9): 2094-104.
17. Decision quality instruments have been developed for fourteen common treatment decisions, including hip and knee osteoarthritis. See Massachusetts General Hospital. Decision quality instruments list [Internet]. Boston (MA): MGH; [cited 2016 Feb 25]. Available from: http://www.massgeneral.org/decisionsciences/research/DQ_Instrument_List.aspx.
18. The instruments have been extensively tested. For example, see Sepucha KR, Stacey D, Clay CF, Chang Y, Cosenza C, Dervin G, et al. Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation. BMC Musculoskelet Disord. 2011;12: 149.
19. Sepucha KR, Fowler FJ Jr, Mulley AG Jr. Policy support for patient-centered care: the need for measurable improvements in decision quality. Health Aff (Millwood). 2004;23: VAR54-62. DOI: 10.1377/ hlthaff.var.54.