SLIDE 1 Strategies to implement shared decision-making in the emergency department
Erik P. Hess MD MSc
Professor of Emergency Medicine University of Alabama at Birmingham @ErikHessMD November 2, 2018
Pat Dunn PhD FAHA
Senior Program Manager Center for Health Technology & Innovation American Heart Association
#PCORI2018
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Clinical Conundrum
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SLIDE 6 Chest Pain Choice Multicenter Trial (n=898)
Outcome Change Patient knowledge
↑
Patient engagement
↑
Placed in EDOU for stress testing
↓ (16%)
Stress testing within 30 days
↓ (8%)
Provider experience
↑
Outpatient follow-up
↑
Safety
↔
Hess, Montori et al. BMJ 2016
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Implementation strategies
- Assemble implementation team
- Perform organizational context assessment
- Integrate HEART score and decision aid into EMR and clinical
workflow
- Design toolkit for dissemination
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Assemble Implementation Team
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Organizational Context Assessment
How Appropriate/Feasible/Acceptable do you think it is to implement Chest Pain Choice in your organization right now? Not at All 1 2 3 4 5 6 7 8 9 10 Very
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Integrate HEART Score and Decision Aid into EMR
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Opens HEART Score form, link to risk- appropriate DA, print
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Insert text in clinical note
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Design Toolkit for Dissemination
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Evaluation plan
- Formative
- Focus groups and clinician surveys at 3, 6, 9 and 12 months
- Summative: RE-AIM framework
- Reach
- Effectiveness
- Adoption
- Implementation
- Maintenance
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How do you get implementation sites on board?
- Ask questions, LISTEN
- Time implementation to organizational readiness
- Lay site-specific groundwork
- UAB: Develop outpatient chest pain evaluation pathway
- Kaiser: Site-specific risk estimates for DA, Tailor outpatient management
- ptions, integrate in EMR
- Mayo: phase III
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Implementation Challenges
- Rapidly collaborating to set-up outpatient chest pain evaluation
pathway at UAB
- Knowing when to delegate
- Standardization versus customization?
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Patient Roles
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American Heart Association Dissemination strategy
Science Translation
Multi-disciplinary Professional Education Courses, Scientific Conferences & Events with reach to global audiences
Diagnosis or Acute Event
Quality & Systems Improvement programs
Care Transitions
Educational tools – print and digital, Self- Management Platforms
At Home
Community Programs, Volunteer Navigators
Science Discovery
Strategically Focused Research Networks, Scientific Statements and Guidelines, Scientific Journals
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Health literacy – Shared decision making model
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Thank You!
Erik P. Hess MD MSc Professor of Emergency Medicine University of Alabama at Birmingham @ErikHessMD Pat Dunn PhD FAHA Senior Program Manager Center for Health Technology & Innovation American Heart Association
