Implementing Shared Decision Making In The Real World
Posted Feb 04 2013 10:30pm
You read the Disease Management Care Blog and use its literature-based links. As a result, you know a lot about shared decision making (SDM) . Based on the randomized control clinical trial data that are regularly linked by the DMCB, you're ready to implement it in your network of primary care clinics. You call your physicians together for a meeting, explain SDM is the best thing since the invention of the Woods lamp and ask them to refer patients to the program.
Except for the part about the DMCB, that's what basically happened at the eight highly regarded medical institutions: Dartmouth-Hitchcock Medical Center, MaineHealth, Massachusetts General Hospital, Mercy Clinics in Iowa, the Oregon Rural Practice–Based Research Network, the Palo Alto Medical Foundation, the Stillwater Medical Group in Minnesota and the University of North Carolina at Chapel Hill. The decision aids covered approximately 50 common conditions such as knee arthritis and prostate enlargement
Three barriers were identified Overworked physicians: given all the other health care needs of their patients, it was difficult to count on physicians to distribute the decision aids. As a result, only 10%-30% of eligible patients participated.
Overconfident physicians: many doctors felt that they were already providing sufficient patient education or that their patients would not benefit from the decision aids. Just telling the docs that this worked was not enough.
Underperforming EHRs: the state-of-the-art information technology could not flag potential patents, remember which individuals had been exposed to the decision aids or record the patients' preferences.
The DMCB ultimately found the answer is to take physicians out of the work flow.
That's what the RAND researchers found. Based on their interviews, they recommend that if you're going to implement SDM in your clinics Automate the process as much as possible and remove human decision-making from the process the triggered the decision aid. That could be done on the basis of pre-existing clinical criteria or when a specialist referral had been arranged.
If automation was not feasible, rely on non-physicians to trigger the decision-aid. For example, office assistants could offer SDM to patients in the course of check-out.