UNC - University of North Carolina, General Internal Medicine
Clinicians and staff at the Division of General Internal Medicine at the University of North Carolina-Chapel Hill will team up with staff from the University’s Sheps Center for Health Services Research to expand their previous research on decision aids. A Foundation demonstration site since 2005, the academic general internal medicine practice is staffed by resident and attending physicians. During prior work, the group studied three models of decision aid distribution: mailed-only, in-office viewing prior to visit, and mailed with follow up during the subsequent visit. Research showed that the mailed-only option was associated with a low cost but resulted in only 20 percent of eligible patients viewing the video. The other two options resulted in higher viewing rates yet required significant time and a dedicated staff member for project tasks.
Based on the knowledge gained from this work, the team plans in the current project to address a number of logistical issues related to decision aid distribution. The project team wants to streamline patient identification through automation. They will use the practice’s patient database and responses to the Patient Health Survey to identify more efficiently patients who would benefit from use of a decision aid on an identified health topic. The team also wants to further study distribution models. Based on their prior work, the team will employ several different strategies for delivering decision aids, selecting the model based on the optimal timing for the particular condition or test.
The UNC team plans to distribute decision aids about preference-sensitive conditions, chronic conditions, and screening decisions. Roll out of new decision aids will be staggered over the three years of the present study. The site currently distributes decision aids about weight loss surgery, chronic pain, colon cancer screening, and prostate cancer screening. The team will roll out decision aids on four additional topics in the first year: benign prostatic hyperplasia, menopause, diabetes, and “Getting the Healthcare That’s Right for You.”
Project leaders plan to fold activities related to the study into those already in place for current continuous quality improvement projects, thus easing the task burden for staff. To assess fully the project’s impact, the team will collect data on the time, challenges, and costs associated with project-related activities. They will assess the number of decision aids delivered relative to the number of eligible patients; the proportion of delivered decision aids that are viewed; patient knowledge and satisfaction through pre- and post-visit questionnaires; and provider experience through surveys. For more information about this implementation project, please contact Project Manager Alison Brenner at alison_brenner@med.unc.edu.