The Palo Alto Medical Foundation (PAMF) is a nonprofit health care organization and a pioneer in multispecialty group practice of medicine. PAMF is a member of Sutter Health, a family of hospitals and physician organizations serving more than 100 communities in Northern California. After merging with two other divisions under the PAMF name, the organization employs more than 1,000 physicians and serves more than 700,000 patients.
PAMF became a Foundation-funded demonstration site in 2009 in order to build a sustainable model to promote shared decision making (SDM) and use of decision aids (DAs).
Current Shared Decision Making Activities
The Palo Alto Medical Foundation demonstration site is a joint collaboration between the Palo Alto Medical Foundation (PAMF), the Palo Alto Medical Research Institute (PAMFRI) and the University of California, San Francisco (UCSF). PAMF has developed a shared decision making initiative known as “Partners in Medical Decision Making” (PMDM) program to study the implementation of decision aids in primary care practice and to examine the effects of DAs on patient care. Currently five primary care sites, one specialty care practice and the three Community Health Resource Centers serve as pilot sites for the project. Each pilot site offers a different suite of Foundation decision aids (Shared Decision-Making® programs) to better serve its community, with a total of seventeen decision aids, including topics related to chronic conditions, end of life decisions, aging, back care, orthopedic and women’s health.
The Community Health Resource Centers house all nine decision aids and patients may schedule an appointment to view a decision aid at the center or borrow the decision aid and view it at home. Nurses at the center are available in person or by phone to discuss the decision aid with the patient.
An Innovative Model for Shared Decision Making
Shared Medical Appointments
The PMDM team has developed a series of three rotating shared medical appointments (SMAs) focused on common health concerns for geriatric patients: memory and the aging brain, fall risk and depression. The personalized evaluations and interventions that patients receive during an SMA empower them to take steps necessary to optimize quality of life.
“I was struck by how frank everybody was about expressing ideas and concerns about aging, and appreciated learning what others think about how to achieve more successful again. It was good to hear that other people have the same issues and it has given me more peace of mind.”
-patient after an SMA series
Clinic Feedback Reports
In addition to gathering feedback from patients and providers about the PMDM program, the team has developed a Clinic Feedback Report that illustrates the following:
- Top distributers of decision aids at each clinic site for previous month
- Announcements about the PMDM program
- Graphs depicting distribution relative to number of patients seen in the clinic who were eligible to receive a decision aid based on data from the electronic medical record (EMR)
This report helps foster the competitive spirit between the clinics, motivating them to continue engaging in the PMDM program and facilitating shared decision making with the support of decision aids.
Marketing Campaign to Spread Awareness of PMDM
To spread awareness of the program at participating clinics and around PAMF, the team developed a marketing campaign that employed brochures, flyers and posters promoting each decision aid topic, as well as the PMDM program. A suite of promotional items with the PMDM logo and tagline “Prescription Strength Information for Better Decisions” was developed as well. To promote shared decision making throughout the organization, the PMDM team gave the first ever Grand Rounds presentation at PAMF that was not focused on a specific disease, but rather on the elements of the program and the importance of integrating shared decision making into primary care. These activities help raise awareness of the concept of shared decision making and the visibility of PMDM beyond the clinic and among key decision makers in the organization.