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Shared Decision Making to Improve Care and Reduce Costs
A sleeper provision of the Affordable Care Act (ACA) encourages greater use of shared decision making in health care. For many health situations in which there’s not one clearly superior course of treatment, shared decision making can ensure that medical care better aligns with patients’ preferences and values. One way to implement this approach is by using patient decision aids — written materials, videos, or interactive electronic presentations designed to inform patients and their families about care options; each option’s outcomes, including benefits and possible side effects; the health care team’s skills; and costs. Shared decision making has the potential to provide numerous benefits for patients, clinicians, and the health care system, including increased patient knowledge, less anxiety over the care process, improved health outcomes, reductions in unwarranted variation in care and costs, and great alignment of care with patients’ values. Continue reading
Posted in Cost, Decision Aid Effectiveness, Health Care Policy, Patient Decision Aids, Patient Preferences, SDM Implementation
Tagged ACA, CMS, Cochrane Collaborative, decision aids, Group Health, health care costs, HHS, IOM, IPDAS, Medicare, NEJM, PCORI, practice variation, shared decision making
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Introducing Decision Aids at Group Health was Linked to Sharply Lower Hip and Knee Surgery Rates and Costs
An observational study reporting the changes in surgical rates and costs in the first eighteen months following the start of a program to introduce decision aids for hip and knee osteoarthritis in the Group Health system. They found a 38% reduction in knee surgeries and a 26% reduction in hip surgeries; findings consistent with results from randomized studies of decision aids. Continue reading
Introducing Decision Aids at Group Health was Linked to Sharply Lower Hip and Knee Surgery Rates and Costs
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. Continue reading
A Multicentre Randomised Controlled Trial Assessing the Costs and Benefits of Using Structured Information and Analysis of Women’s Preferences in the Management of Menorrhagia
Objectives To develop decision aids to provide evidence-based information and formal preference elicitation for women with menorrhagia; and to evaluate their effects on patient outcomes, patient management and cost effectiveness. Continue reading
Shared Decision Making & Medical Costs
The strongest argument for shared decision making is that patients have a fundamental right to understand all the reasonable medical options and the arguments for and against each option. Simply put, informing and involving patients in medical decisions is the right thing to do. By being informed and involved, patients have the ability to avoid having surgery that exposes them to risks they do not think are worth the benefits. In addition to those certain benefits, the evidence is also mounting that shared decision making is likely to pay for itself — and it may well do better than that. Continue reading
A Randomized Trial of a Telephone Care-Management Strategy
This article reviews a research study where patients with selected medical conditions and predicted high health care costs were given telephone-based care-management coaching to instruct them about SDM, self-care and behavioral change. This research goes beyond previous care-management studies because it included patients at risk for a preference-sensitive condition decision in the future, and the health coaching included shared decision making and access to patient decision aids. The average monthly medical and pharmacy costs per person in the enhanced-support group were 3.6% lower than those in the usual-support group, largely due to a 10.1% reduction in annual hospital admissions. Continue reading
Posted in Cost
Tagged decision aids, NEJM, preference-sensitive condition, shared decision making
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Informing and Involving Patients in Medical Decisions: The Primary Care Physicians’ Perspective
The Informed Medical Decisions Foundation commissioned Lake Research Partners (LRP) to conduct research with primary care physicians about SDM and patient decision aids. These are the results: Increasingly, patients are faced with medical decisions that have many options, uncertain outcomes, and benefits and harms that are valued differently by each individual. Shared decision making (SDM) recognizes the importance of having patients and providers work together to select tests and treatments. Patients and providers bring different expertise to the decision. Providers are mainly responsible for assimilating and appropriately applying evidence-based information and patients are responsible for sharing their preferences. Using SDM, well informed patients and providers can determine which choice matches what is most important to patients — delivering high quality care that is both evidence-based and patient-centered. Continue reading
Bending the Curve: Technical Documentation
This document includes a cost analysis of implementing SDM for eleven procedures and estimates the savings to national health spending to be $3.8 billion over 5 years and $9.2 billion over ten years. Continue reading
Posted in Cost
Tagged decision aids, health care costs, national health care, shared decision making, The Lewin Group
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Are Patient Decision Aids for Total Joint Replacement Cost-Effective and Do They Optimize the Surgical Referral Process from Primary Care
The overall goal of this study is to evaluate the effects of patient decision aids (pDAs) on improving decision quality and reducing length of surgical consults for TJA, and their cost-effectiveness. Continue reading
