Abstract
Advances in shared decision making (SDM) have not successfully translated to practice. We describe our experience and lessons learned in translating an SDM process for primary care cardiovascular disease management. The SDM process operationalized recognized SDM elements using workflow modifications, a computerized patient questionnaire, an automated risk calculator to identify at-risk patients, a web-based tool for patients to choose interventions, automated feedback on the personalized benefits of choices, and a web-based tool for providers to view patient risk, patient choice, and expert advice. Although medication was typically the intervention resulting in the greatest risk reduction, the majority of patients preferred dietary and other lifestyle changes. Patients generally favored the opportunity to make and communicate choices. However, providers only viewed patient choice data in 20% of the encounters. Translation of the SDM process was successful for patients and the difference between patient choice and optimal risk reduction points to the importance of engaging in an SDM process. Lack of engagement by providers may be due to “alert fatigue” or to the failure of the SDM process to improve efficiency in the office visit.
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Acknowledgments
The authors would like to acknowledge AstraZeneca for funding provided for this project. The authors would also like to acknowledge editorial assistance provided by Ilene Ladd, project coordinator.
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Implications
Practice: Key elements of shared decision making (e.g., defining the problem, presenting options, eliciting treatment preferences) can be efficiently integrated into the clinical workflow using web-based tools that improve patient satisfaction, quality of care, and productivity.
Policy: The meaningful use of health information technology for improving care quality and efficiency and for engaging patients in their healthcare will likely be enhanced by using efficient means of obtaining digital data directly from patients on risks, preferences, needs, and outcomes.
Research: There continues to be a significant gap in devising a care model that seamlessly and efficiently integrates shared decision making into the workflow in a manner that is easy for clinical practices to adopt.
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Jones, J.B., Bruce, C.A., Shah, N.R. et al. Shared decision making: using health information technology to integrate patient choice into primary care. Behav. Med. Pract. Policy Res. 1, 123–133 (2011). https://doi.org/10.1007/s13142-011-0023-5
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DOI: https://doi.org/10.1007/s13142-011-0023-5