Presentation on theme: "Large Scale Implementation of Patient Decision Aids in an Integrated Group Practice: the Group Health Experience David Arterburn, MD, MPH Group Health."— Presentation transcript:
Large Scale Implementation of Patient Decision Aids in an Integrated Group Practice: the Group Health Experience David Arterburn, MD, MPH Group Health Research Institute May 25, 2011 “University of Washington SDM Conference - Implementing Shared Decision Making: Lessons from the Front”
About Group Health Group Health is an integrated health plan and care delivery system that provides medical coverage and care to more than 674,900 residents in Washington state and North Idaho. Nearly two-thirds of members receive care in Group Health-owned/operated medical facilities from Group Health- salaried providers.
Patient-centered care at Group Health Shared electronic medical record Medical home pilot Decision aids for shared decision making Implementation timeline 2011 Evaluation of decision aids continues
Shared decision making research System-wide implementation 3-year research project Foundation support
Primary aims of the evaluation Assess impact on surgery use Assess impact on total health care use and costs Estimate ROI from health plan and purchasers’ view Assess process barriers and facilitators
How did we implement decision aids at Group Health?
Treatment choices in 6 specialty areas Orthopedics Cardiology Urology Women’s health Breast cancer Back care
12 preference-sensitive conditions Orthopedic s CardiologyUrology Women’s Health Breast Cancer Back Care 1.Hip osteoarthriti s 2.Knee osteoarthriti s 3.Coronary artery disease 4.Benign prostatic hyperplasia 5.Prostate cancer 6.Uterine fibroids 7.Abnormal uterine bleeding 11.Spinal stenosis 12.Herniated disc 8.Early stage 9.Ductal carcinoma in situ 10.Breast reconstruction
Providers can order DAs through Epic
Patient portal access DVDs can be viewed on the Web
What have we learned about the use of decision aids at Group Health?
Evaluation Ordering & viewing Provider interviews Patient survey link link Patient survey link link
Decision aid distribution (4/11) Number of videos Distributed, by month Total 10, 700
Decision aid distribution (4/11)
Decision aid distribution in Ortho
DA distribution in Women’s Health
DA distribution in Urology
DA distribution for Cardiology
DA distribution for Gen Surgery
DA distribution for Neurosurgery
Percentage of procedures for preference sensitive conditions where patient did not receive the video Fewer missed opportunities
Provider perspectives “It’s almost like you can’t give them too much information. You know? When it really comes down to it, you need to give people enough information so that they sort of really understand the impact of the decision and all the implications and not just the surgeon’s view.” ~Orthopedics MD “I don’t have any problem with any kinds of information given to any patients at any time. The more information a patient has, the easier it is for me. Even if it’s wrong, because then they can ask me intelligent questions.” ~Cardio MD “It’s complicated because you don’t have all the clinical data that you need to make a decision until you’ve taken the angiogram. And there is a strong incentive to deal with it right after you’ve done the angiogram. So, the incentives being: it’s more efficient, it’s more comfortable for the patient, and… if you ask them the question, “Do you want us to just do what we think is best or do you want us to stop and then we can have plenty of time to talk it over later,” they nearly always will tell you, “No, just do what you think is best.” That’s the clear majority view in this.” ~Cardiology MD “Some patients seem to really appreciate them. Some patients seem really scared after watching the DA and some of the material on there...It really does increase the time I’m spending with them, almost uniformly… It doesn’t save any time at all. And it’s making me run late having to address all the issues the patient has after watching the DA.” ~General Surgery MD
Overall rating of decision aid videos Patient survey, September2010, 950 responses Helped you understand the treatment choices Helped you prepare to talk with provider Patient assessment
Overall rating of decision aid videos Patient survey, September 2010, 975 responses How important is it that providers make programs like this available?
Rating of decision aid videos, by topic September 2010 Patient assessment Helped understand treatment choices Helped prepare to talk with provider How important that providers make programs like this available Excellent or very goodExtremely or very important Percent of patients rating:
Barriers & Facilitators Engaging providers in establishing the implementation processes is important for buy-in. Overall, the amount of time spent by providers talking to patients has not changed Changing providers’ practice regarding how they talk with patients about health care choices and personal values needs to be actively cultivated. Having a mechanism for pre-visit ordering increases distribution of the DAs and allows for efficient follow up conversations about treatment choices with patients. Using DAs for conditions that are perceived by patients and/or providers as life threatening is more difficult to implement (e.g., DA for coronary artery disease).
Problems/issues/things to improve…? Getting the right patient at the right time. Knowing that the patient watched the DA. Knowing that a follow-up conversation took place. Tracking which patients watched the DA and decided NOT to have surgery at this time. Getting follow-up with patients at 12mo+ to check if they were happy with their decision.