1. Policy Research Shop Support for the Policy Research Shop is provided by the Ford Foundation and by the Fund for the Improvement of Postsecondary Education, U.S. Department of Education. Policy Research Shop Shared Decision Making: Policy Options for New Hampshire Catie Burkhard Karen Doster Hope McIntyre 1

2. Policy Research Shop Outline I.Overview of shared decision making II.Current research on shared decision making III.Challenges IV.Profiles of shared decision making in practice V.Policy options 2

3. Policy Research Shop What is Shared Decision Making? “A collaboration between patients and providers to engage in open communication, which allows patients to choose care options that are based on the best available evidence and optimally suit their needs and preferences.” 1 1. "What is Shared Decision Making?" Foundation for Informed Medical Decision Making. 22 May 2011.. 3

4. Policy Research Shop Background Information The Dartmouth Atlas research Health utilization differences Effective care, preference-sensitive care, supply-sensitive care – Example: PSA testing 4

5. Policy Research Shop Forms: Pamphlets, booklets Decision guides Online tutorials Videos Websites Information Contained: Description of the illness/disease Pros/cons of treatment options Frequently asked questions Thought-provoking questions about reader’s values and preferences Decision Aids 5

6. Policy Research Shop Survey of Current Research I.Increased patient knowledge II.Decreased decisional conflict III.Potential legal implications IV.Decreased medical care utilization 6

7. Policy Research Shop Topics for further research I.Evaluate long-term health outcomes II.Quantify benefits of patient satisfaction III.Standards for decision aids 7

8. Policy Research Shop Challenges to Implementation Challenges: System Resource constraints Physicians Interpersonal skills Time constraint Information requirements Patient Literacy Numeracy Other Defining protocol Standardizing aids 8

9. Policy Research Shop Where is this happening now? I.Washington State II.Dartmouth-Hitchcock Medical Center III.Philadelphia, PA 9

10. Policy Research Shop Where is this happening now? I.Washington State SB 5930 passed in 2007 making SDM a high standard of informed consent Washington State Health Care Authority demonstration project 10

11. Policy Research Shop Where is this happening now? II.Dartmouth-Hitchcock Medical Center Center for Shared Decision Making formed in 1999 Center for Informed Choices (CIC) within TDI Breast cancer, spine disorders, prostate cancer 11

12. Policy Research Shop Where is this happening now? III.Philadelphia, PA Patient Provider Decision Sharing Project Integrates SDM in primary care clinics Patients: high Medicaid population, low literacy, non-native English speakers 12

13. Policy Research Shop Policy Options I.No action at this time II.Statement of support III.Partnerships with DHHS IV.Creating incentives V.Mandating use of shared decision making 13

14. Policy Research Shop Policy Options I.No action at this time 14

15. Policy Research Shop Policy Options II. Statement of Support 15

16. Policy Research Shop Policy Options III. Partnerships with DHHS Hospitals and clinics Insurance plans Medical schools 16

17. Policy Research Shop Policy Options IV. Changing incentives Medical malpractice Reimbursement structure 17

18. Policy Research Shop Policy Options V. Mandating use of shared decision making State-wide Medicaid State employee insurance 18

19. Policy Research Shop Support for the Policy Research Shop is provided by the Ford Foundation and by the Fund for the Improvement of Postsecondary Education, U.S. Department of Education. Policy Research Shop Thank you 19