Shared Decision Making Were in This Together Michael J. Barry, MD President.
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Transcript of Shared Decision Making Were in This Together Michael J. Barry, MD President.
Shared Decision MakingWe’re in This Together
Michael J. Barry, MDPresident
We Believe Patients Should Be
Why Shared Decision Making in Health Care?
Evidence of the Problem
The DECISIONS StudyA Portrait of How Americans Make
Common Medical Decisions
Medical Practice Variation40 Years of Research
Documenting Inconsistent Care
Poor Decision QualityPoor Decision Quality
Patients: Making Decisions in
the Face of Avoidable
Ignorance
Clinicians: Poorly “Diagnosing” Patients’ Preferences
Shared Decision Making
(Charles C, Soc Sci Med 1997; 44:681)
Clinician and patient work together
They share information
About options and outcomes
About preferences
They work toward a consensus about the preferred test or treatment
They reach an agreement on the test or treatment to implement
Supporting the Concept SDM supported by patient
decision aids improves decision quality
Both patients and physicians support SDM
Implementation models are demonstrating that SDM can work “in the trenches”
O’Connor et al. Cochrane Database of
Systematic Reviews, 2009
Foundation Demonstration Sites Primary Care Specialty Care
Dartmouth Hitchcock Medical Center XWhite River Junction VA XMassachusetts General Hospital XUniversity of North Carolina XMaine Health XMercy Clinics Inc. XStillwater Medical Group XOregon Rural Practice Based Research Network XPalo Alto Medical Research Foundation X XGroup Health Cooperative X
Everett Clinic X XMulti-Care Health System X XVirginia Mason Medical Center X XAllegheny General Hospital - Breast Center XCarol Milgard Breast Care Center XUniversity of California San Francisco - Breast Center XDHMC - Breast Center XDHMC - Urology XDHMC - Orthopedics XDHMC - Spine Center XDHMC - Cardiology X
Non-Funded Demonstration SitesMackey Family Practice XPeace Health (Oregon) XMercy Cancer Center (Oklahoma) X
Shared Decision Making
TRENDSShared Decision Making
TRENDS
Patient Protection and Affordable Care Act
HR3590 Section 936Program to Facilitate Shared Decision Making To facilitate collaborative process between patients and
providers .. and to incorporate patient preferences and values into medical plan
Authorized not AppropriatedAuthorized not Appropriated
Key Aspects of PPACA Section 936
1. Produce patient decision aids2. Set quality standards and certify decision aids3. Create Shared Decision Making Resource Centers4. Grant funds to providers for development, use and
assessment of SDM techniques using certified decision aids
Section 3021 CMS Innovation Center Test innovative payment models to reduce
expenditures and to enhance quality of care
Option #9Assisting applicable individuals in making informed health care
choices by paying providers for using patient decision support tools that improve individual understanding of medical options
Section 931 Quality Measures DevelopmentAssessment of experience, use and quality of information provided to
patients to inform decision making including the use of SDM tools
Shared Decision Making is at the Core of Ethical, Patient Centered
Care
Patient Centered Medical Home Accountable Care Organizations
Meaningful Use of Health Information Technology (HIT)
Patient Centered Medical Home Accountable Care Organizations
Meaningful Use of Health Information Technology (HIT)