A new study published in the May issue of Health Affairs finds that some patients are concerned about being labeled “difficult” if they ask too many questions or disagree with a recommendation from their physician. “We found that patients want to participate in making decisions with their physicians, but feel vulnerable and worried that they might be perceived as too assertive, resulting in lower quality care in the future,” says Dr. Dominick Frosch, lead author of the study.
After introducing video-based decision aids for people with knee and hip osteoarthritis, Group Health Cooperative saw a significant drop in rates of elective knee and hip replacement surgeries, as well as a drop in the cost of care. According to an article in the September issue of Health Affairs, Group Health found that introducing these decision aids resulted in a 38 percent reduction in knee replacement surgeries, a 26 percent reduction in hip replacement surgeries and a 12 percent decline in health care costs over a six month period.
Arterburn D, Wellman R, Westbrook E, et al. Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs. Health Aff. 2012 Sept 4;(9):2094-104.
This article describes the current issues surrounding informed patient decision making and how the use of SDM might improve informed decision making. The authors suggest using health information technology to bolster the use and simplify the implementation of SDM, by using it to trigger the delivery of information and collect and store information. The authors also suggest the use of additional surveys to assess patients’ knowledge and goals. The article reviews public and private developments that could facilitate the development of tools and methods to improve patient-centered care. Finally, the authors review policy options for implementation of SDM.
This article proposes that a new measure of decision quality be implemented in health care settings in order to ensure that patients receive the care they want and understand their health care decisions through measuring concordance of care given to patient preferences. The authors state that the quality of a clinical decision is the “extent to which it reflects the considered needs, values, and expressed preferences of a well-informed patient and is thus implemented.” They suggest that a valid assessment of decision quality would require: 1) decision-specific knowledge 2) values for the salient outcomes and 3) treatments chosen. The paper provides examples where similar measures have been incorporated into care processes.