Physician Practice Roundtable The Case for Shared Decision

Physician Practice Roundtable The Case for Shared Decision Making Board Update from the Physician Practice Roundtable May 2018

2 Giving Patients More Input in Their Care Shared Decision Making Creates a Collaborative Visit Changing the Roles of the Visit Traditional Roles Future Roles Provider role • Discern which intervention is in the patient’s best interest • Help patient uncover values, goals for care Patient role • Consent to the intervention that the physician considers best • Work in partnership with provider to understand values, goals for care © 2017 Advisory Board • All Rights Reserved • advisory. com • Help determine which intervention meets patients’ priorities Source: Emanuel EJ and Emanuel LL, "Four Models Of The Physician-Patient Relationship, " JAMA, 267, no. 16 (1992): 2221 -2226, cited in Gawande A, Being Mortal, New York: Holt, Henry & Company, Inc. , 2014, 199 -202; Lown B, et al, “An Agenda for Improving Compassionate Care: A Study Shows About Half of Patients Say Such Care is Missing, ” Health Affairs, 2011, http: //content. healthaffairs. org/content/30/9/1772. long; Advisory Board nterviewsand analysis.

3 Benefits of Shared Decision Making Care Quality Cost Control • Greater identification of preventable complications • 5. 3% lower overall medical costs for patients who received decision support • Increased adherence to care plan • 13% increase in patient knowledge of treatment options • 12. 5% fewer hospital admissions among patients who participated in shared decision making with physicians Increased Loyalty Patient and Physician Satisfaction • 47% of patients who experienced shared decision making would switch to a provider who offers it • 91% of patients who viewed a decision aid would recommend it to family friends • “The new PCP is known for making sure patients understand their illness and treatment plan” ranked 2 nd out of 10 provider attributes linked to loyalty • 74% of physicians exposed to decision tools want to use them again Source: ; Roades C, “The New Imperative Of Patient Engagement For Hospitals And Health Systems, ” Health Affairs Blog, February 15, 2013, http: //healthaffairs. org/blog/2013/02/15/the-new-imperative-ofpatient-engagement-for-hospitals-and-health-systems/; Montori V, “SDM short 15 minute with voice over, ” Slide Share, https: //www. slideshare. net/kerunit/sdm-short-15 minwithvoiceover; Goldbach P, “Power to the patient: Shared decisionmaking improves care and reduces costs, ” Modern Healthcare, April 6, 2013, http: //www. modernhealthcare. com/article/20130406/MAGAZINE/304069987; Montori V, “Increasing patient engagement with shared decision making, ” Mayo Clinic, April 16, 2015, http: //shareddecisions. mayoclinic. org/2015/04/16/increasing-patient-engagement-with-shared-decision-making/; Market Innovation Center, “What Drives Consumer Loyalty to a Primary Care Physician? , ” The Advisory Board Company, 2015; Goldbach P, “Implementing Shared Decision Making at the Point of Care, ”Health Dialog, 2017, http: //info. healthdialog. com/download-white-paper-implementing-shared-decision-making; Ernest A, “Shared Decision Making: Engaging Patients to Improve Health Care, “ Families USA, May 2013, http: //familiesusa. org/sites/default/files/product_documents/ Shared-Decision-Making. pdf; Advisory Board interviews and analysis. © 2018 Advisory Board • All Rights Reserved • advisory. com

4 Decision Aids: One Tool for Shared Decision Making Decision Aids Improve Physician-Patient Collaboration What Is a Patient Decision Aid? A tool used to inform patients about available treatment options and help them evaluate the benefits and drawbacks of each based on their personal values Common Forms Video Pamphlet Discussion guide Web-based tool Proven Benefits of Decision Aids ü Enhance physician-patient communication ü Prompt greater patient participation in care decision making ü Improve patient knowledge of treatment option, clarify values and priorities Study in Brief: Cochrane Decision Aid Systematic Review • Meta-review that assessed the effects of decision aids on people facing treatment or screening decisions; reviewed over 105 studies on decision aids • Included only published randomized controlled trials that compare the use of decision aids to usual care and/or other alternative interventions © 2018 Advisory Board • All Rights Reserved • advisory. com Legare S, et al, “Decision aids help people who are facing health treatment or screening decisions, ” Cochrane Library, April 12, 2017, http: //www. cochrane. org/CD 001431/COMMUN_decision-aids-helppeople-who-are-facing-health-treatment-or-screening-decisions; Advisory Board interviews and analysis.

5 Goal of Decision Aids to Elicit Patient Preferences Excerpt from Mayo Clinic’s Diabetes Medication Choice Cards Additional topics covered within Diabetes Medication Choice Decision Aid include low blood sugar, daily sugar testing, and weight change © 2018 Advisory Board • All Rights Reserved • advisory. com Source: Shared Decision Making National Resource Center, Mayo Clinic, http: //shareddecisions. mayoclinic. org/; Advisory Board interviews and analysis.

6 Advisory Board Resource: Patient Decision Aid Toolkit Equipping Physicians to Engage in Shared Decision Making What’s Included: • Decision aid cheat sheet to equip practice leaders with talking points, basic grounding in SDM • Free, ready-to-use Diabetes Medication Choice Decision Aid from Mayo Clinic • Conversation roadmap to help physicians engage in SDM with patients • Role-play workshop facilitator materials to familiarize physicians with using decision aids Access the toolkit at advisory. com/ppr/shareddecisionmaking © 2018 Advisory Board • All Rights Reserved • advisory. com Source: Advisory Board interviews and analysis.