Lessons learned implementing patient decision support in routine - PowerPoint PPT Presentation

Lessons learned implementing patient decision support in routine care Dominick L. Frosch, PhD

How do we engage patients in making choices about their care?

Partners in Medical Decision Making Prescription Strength Information for Better Decisions Better Decisions --Together Lin, Halley, Rendle, Tietbohl, May, Trujillo & Frosch (2013). Health Affairs.

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But aggregate outcomes don’t tell the whole story

Few eligible patients received decision support Overall Decision Aid Distribution and Proportion of Patients Reached for CRC Screening & Back Pain 30.00% 350 300 25.00% 250 # of Decision Aids Distributed 20.00% % of Eligible Patients Reached 200 15.00% 150 10.00% 100 5.00% 50 0.00% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Project Month % Reached for Combined CRC & BP Note : The red line corresponds to the y-axis at the left, and depicts the percentage of potentially eligible patients who Distribution Totals for All Topics received a decision aid for either colon cancer screening or back pain across all five clinics. The blue line corresponds

One patient’s story • Patient saw physician for annual physical exam. – MD provided decision support on colon cancer I prefer screening. Patient reviewed it home. this • Patient contacted physician via online option patient portal. – Requested stool test option. – Physician refused: “ We only believe in 2 options: colonoscopy or flexible sigmoidoscopy ”. • Patient confused, unsure what to do and indicated she was unwilling to assert her Lin, Trujillo & Frosch, 2012 ; preferences and disagreement. Archives of Internal Medicine

Why was this so hard? • Physicians prefer to be in control of decisions • Physicians claim they don’t have enough time to provide DESIs to patients • Paradoxically high utilizers think they save time • But it has to be made as easy as possible • And engaging patients has to be measured, monitored and rewarded

Elwyn et al. Patient Education & Counseling. 2013 Oct;93(1):102-7. Barr et al. J Med Internet Res. 2014 Jan 3;16(1):e2. Thinking about the appointment you have just had ... 1. How much effort was made to help you understand your health issues? 0 1 2 3 4 5 6 7 8 9 No effort Every effort at all was made 2. How much effort was made to listen to the things that matter most to you about your health issues? 0 1 2 3 4 5 6 7 8 9 No effort Every effort at all was made 3. How much effort was made to include what matters most to you in choosing what to do next? 0 1 2 3 4 5 6 7 8 9 No effort Every effort at all was made