Advancing Shared Decision Making
The Informed Medical Decisions Foundation, now a division of Healthwise, has been working to advance evidence-based shared decision making since 1989. We believe the only way to ensure that high quality health care decisions are being made is for a fully informed patient to participate in a shared decision making process with their clinician. Through our research and advocacy efforts, we are dedicated to helping people make better health decisions.
I attended the 6th annual Wennberg International Collaborative (WIC) Fall Research Meeting in London September 2-4, 2015. This invitation-only meeting is a collaboration between The Dartmouth Institute (TDI) and the London School of Economics and Political Science (LSE). The WIC is a research network committed to improving health care by examining organizational and regional variation in health care resources, utilization, and outcomes. The goal of the collaboration is to better understand the causes and consequences of unwarranted variation—that is, variation in health care not explained by differences in population needs or preferences—around the world, leading to clinical improvement and policy change.
The collaboration also celebrates and extends globally the work of Jack Wennberg, founder of The Dartmouth Atlas and cofounder of the Informed Medical Decisions Foundation. Although Jack couldn’t attend this year, Al Mulley, also cofounder of the Foundation, represented Dartmouth. David Goodman, a pediatrician and health services researcher, as well as coprincipal investigator of The Dartmouth Atlas, cochaired the meeting with Gywn Bevan, professor of health policy at the LSE.
About 65 people from 20 countries attended the meeting, held at the Royal College of Surgeons of England. The meeting focused on scientific data presentations describing practice variations, but there were policy presentations on addressing those variations as well, particularly from England, Scotland, Spain, New Zealand, and Australia; the Australians seemed particularly adept at policy interventions to address unwanted practice variations.
The meeting was largely a forum to establish collaborations and provide constructive comments on ongoing work from like-minded people; most attendees were researchers working on practice variation in their own countries, and many had attended previous WIC gatherings. The plenary speakers were Elliot Fisher, director of TDI, who spoke about the Accountable Care Organization movement in the U.S.; Andreas Taenzer, an anesthesiologist from Dartmouth, who talked about reducing variation in sepsis care to improve outcomes in the High Value Health Collaborative; Estella Geraghty, chief medical officer at Esri, who talked about creating “Smart Hospitals” using Esri’s geographic information system (GIS) software; and myself. I talked about shared decision making (SDM) as an “antidote” for unwanted practice variation. A number of investigators from different countries approached me about how SDM could be studied and advanced in their own countries.
Anne Brabers, a researcher from the Netherlands, presented a clinical trial of a decision support program to help women decide about single (less effective) or dual (higher likelihood of twins) embryo implantation following in vitro fertilization. They documented a modest reduction in practice variation across hospitals using this approach.
One limitation of global research in practice variation is the availability of data. Members of the collaborative developed a statement that addresses this limitation, “Driving Health Care Improvement Without a Map: A Call for Improved Data Availability.” The “bottom line” of the document: “We as members of the Wennberg International Collaborative call for full and open access to health care data and information for legitimate research and policy analysis.” Many individuals at the meeting, including myself, endorsed the statement.
Going forward, WIC plans to have a “roving” international meeting in the spring that will be country-specific (this year it was held in Berlin), and the fall meeting in London as usual. For my part, I was honored to attend the meeting on behalf of the Informed Medical Decisions Foundation and Healthwise, and I look forward to further work in support of addressing unwanted practice variation.
A significant challenge in serving the Medicare population is how to provide quality care while still ensuring financial stability and growth. Looking at the current state of health systems, overall they run a pretty modest profit margin of 6.5%. Overall occupancy rate is 61%, but the majority of that percentage is Medicare patients. This group of patients runs about a -5.4% margin and holds a disproportionate share of the occupied beds in the health system per hospital. What this means is that Medicare patients, whose numbers are increasing, must be managed effectively. Continue reading
Every other year, members of the shared-decision-making community gather in a different hub of the world to discuss the evolution of patients and providers engaging in a collaborative conversation around health care decisions. This July, the gathering was quite the landmark event as shared decision making and evidence-based practice united at the first joint International Shared Decision-Making/International Society for Evidence-Based Health Care (ISDM/ISEHC) Conference in Sydney, Australia. Over 300 people from around the globe met at the University of Sydney July 19–22 to share knowledge and inspire action to improve the entire care experience. Continue reading
By: Michael J. Barry, MD and Patty Skolnik Editor’s note: The following exchange is a conversation between Patty Skolnik and Michael Barry regarding the current controversy about physicians’ maintenance of their licensure and certification. Patty Skolnik is the founder and … Continue reading
In a 2012 report for The King’s Fund, Foundation cofounder Al Mulley and colleagues described the problem of misdiagnosis of patients’ preferences. “Preference misdiagnosis” may be the most common form of medical error in health care. It can occur when a person has more than one medically reasonable course of action open to him or her. A clinician, sometimes supported by recommendations from clinical practice guidelines, may prescribe or withhold a treatment based on what the evidence best supports and what he or she thinks the patient would want. However, research shows that among fully informed patients who understand a certain treatment’s possible benefits and risks, some would want that prescribed treatment, and some would not want that treatment prescribed. While there is evidence that preference misdiagnosis occurs, its epidemiology and solutions have not been well described. Continue reading