1. Shared Decision Making Were in This Together Michael J. Barry, MD President

2. We Believe Patients Should Be Supported & encouraged to participate in their health care decisions Fully informed with accurate, unbiased & understandable information Respected by having their goals & concerns honored

3. Why Shared Decision Making in Health Care?

4. Evidence of the Problem The DECISIONS Study A Portrait of How Americans Make Common Medical Decisions Medical Practice Variation 40 Years of Research Documenting Inconsistent Care

5. Poor Decision Quality Patients: Making Decisions in the Face of Avoidable Ignorance Clinicians: Poorly Diagnosing Patients Preferences

6. 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

7. 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 OConnor et al. Cochrane Database of Systematic Reviews, 2009

8. Foundation Demonstration Sites Primary CareSpecialty Care Dartmouth Hitchcock Medical CenterX White River Junction VAX Massachusetts General HospitalX University of North CarolinaX Maine HealthX Mercy Clinics Inc.X Stillwater Medical GroupX Oregon Rural Practice Based Research NetworkX Palo Alto Medical Research FoundationXX Group Health CooperativeX Everett ClinicXX Multi-Care Health SystemXX Virginia Mason Medical CenterXX Allegheny General Hospital - Breast CenterX Carol Milgard Breast Care CenterX University of California San Francisco - Breast CenterX DHMC - Breast CenterX DHMC - UrologyX DHMC - OrthopedicsX DHMC - Spine CenterX DHMC - CardiologyX Non-Funded Demonstration Sites Mackey Family PracticeX Peace Health (Oregon)X Mercy Cancer Center (Oklahoma)X

9. Shared Decision Making TRENDS

10. Patient Protection and Affordable Care Act HR3590 Section 936 Program 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 Appropriated

11. Key Aspects of PPACA Section 936 1.Produce patient decision aids 2.Set quality standards and certify decision aids 3.Create Shared Decision Making Resource Centers 4.Grant funds to providers for development, use and assessment of SDM techniques using certified decision aids

12. Section 3021 CMS Innovation Center Test innovative payment models to reduce expenditures and to enhance quality of care Option #9 Assisting 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 Development Assessment of experience, use and quality of information provided to patients to inform decision making including the use of SDM tools

13. 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)

14. Thank You! mbarry @ fimdm.org www.informedmedicaldecisions.org mbarry @ fimdm.org www.informedmedicaldecisions.org