MGH - Massachusetts General Hospital

General Medicine and John D. Stoeckle Center for Primary Care Innovation

 

The Massachusetts General Hospital (MGH) primary care implementation program is based at the Stoeckle Center for Primary Care Innovation at the MGH General Internal Medicine Unit. The hospital oversees 15 adult primary care practices located in Boston and surrounding communities that collectively provide care for about 150,000 patients. Internal Medicine Associates, the pilot site of the initial Foundation demonstration project, is MGH’s largest practice, with 75,000 annual visits to 53 attending physicians, 85 resident physicians, and 21 nurses and nurse practitioners. Clinicians and staff at the site have been involved in the Foundation demonstration project since 2005.

The project team’s early work suggested that increasing the ease with which clinicians could provide materials to patients was a crucial first step in facilitating shared decision-making and collaborative care. Their efforts focused on developing the necessary system support to allow primary care providers to prescribe shared decision-making programs through the electronic medical record, thus allowing clinicians to order shared decision-making resources in real time during a primary care visit.

The team also developed a standard process for decision aid distribution, which includes the following steps:

• The provider determines during a patient visit that a patient is eligible for a shared decision-making program and discusses the program with the patient;




• If the patient expresses interest, the provider “prescribes” a video or DVD through the electronic medical record;




• Staff from the hospital’s Family Learning Center mails the ordered decision aid to the patient, along with a return mailer and an evaluation questionnaire; and




• A note is automatically created in the electronic medical record documenting that program was sent.

 

The team will continue to use this established distribution model during the current project and will continue to distribute 22 different decision aids, in the areas of colon cancer screening, diabetes, orthopedics, heart disease, depression, general health, prostate conditions, and women’s health.

As a component of the initial demonstration project, the project team assessed the differences between providers who prescribed decision aids and those who did not. Based on these results, the team has planned a number of interventions to support decision aid use. Specifically, they will strive to increase the familiarity of the providers with decision aid content through learning activities with CME credit and increase awareness of the programs through additional reminders and training sessions.

The team also will continue to use academic detailing and “advertising” to heighten awareness of the programs. They will emphasize the advantages of the decision aids identified by the providers who prescribe them—ease of use and quality of the programs—to encourage other providers to use the programs. The project team plans to increase follow-up with patients after decision aids are prescribed (“closing the loop”) through phone calls and chart review. For more information about this implementation project, please contact Lauren Leavitt, Senior Clinical Research Coordinator at ljleavitt@partners.org.