Shared Decision Making in the Real World: Successes and Challenges

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Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013

Neil Korsen, MaineHealth
Larry Morrisey, Stillwater Medical Group
Charlie Brackett, Dartmouth-Hitchcock Medical Center
Grace Lin, Palo Alto Medical Foundation
Carmen Lewis, University of North Carolina
Leigh Simmons, Massachusetts General Hospital

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  • Strong leadership supportDefined Patient Centered Care Recognized the value it brought to the organizationChanged the cultureCareful attention to processStarted small and grew steadilyTeam effortWork has the chance to improve care at the larger ACO we have joined
  • Shared Decision Making in the Real World: Successes and Challenges

    1. 1. S h a r e d D e c i s i o n M a k i n g i n t h e R e a l W o r l d : S u c c e s s e s a n d C h a l l e n g e s Aligning Incentives for Patient Engagement May 23, 2013
    2. 2. Decision Support Coaching: Whose job is it? Neil Korsen MaineHealth May 23, 2013
    3. 3. Shared Decision Making at Stillwater Medical Group
    4. 4. Integrating and Rewarding Patient Engagement through Shared Medical Appointments Grace Lin, MD University of California, San Francisco glin@medicine.ucsf.edu
    5. 5. Visit Planner 6
    6. 6. http://ahealthypartnership.org/ A Healthy Partnership
    7. 7. Physician Requests 3 33 62 67 118 126 127 109 95 89 87 0 20 40 60 80 100 120 140 2011 Q1 2011 Q2 2011 Q3 2011 Q4 2012 Q1 2012 Q2 2012 Q3 2012 Q4 2013 Q1 2013 Q2 2013 Q3/4
    8. 8. Satisfaction 88% 88% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Like getting information Found it useful n=390
    9. 9. Typical primary care visit at PAMF for an older patient with chronic disease 70 year old man with diabetes, high blood pressure, heart disease EMR Agenda Overdue colon cancer screening Overdue diabetes screening Clinic agenda LEAN implementation EMR Meaningful Use Hit RVU targets MD agenda for chronic disease management New symptoms Lab review Medication review & adjustment Counseling diet & exercise Added: Partners in Medical Decision Making Decision aids Shared decision making Patient agenda Back pain Constipation Preventive medicine Diet and exercise Counseling on harmful habits Comprehensive geriatric assessment
    10. 10. &
    11. 11. DHMC Center for Shared Decision Making
    12. 12. Utilizing IT to facilitate SDM • Eligible patients are presented with a brief description of the screening decision, asked their preference, and offered a DA.
    13. 13. Streaming video Written Information
    14. 14. • Patients are asked to complete questions assessing their knowledge and values
    15. 15. SDM: Clinician Report
    16. 16. Taking a chance on it
    17. 17. The patient’s perspective
    18. 18. Seeing the benefit
    19. 19. The change sticks
    20. 20. Members Affiliates Maine Mental Health Partners Lincoln County Healthcare HomeHealth Visiting Nurses Maine PHO Mid-Coast Hospital MaineGeneral Medical Center Maine Medical Center PenBay Healthcare Western Maine Health St. Mary’s Regional Medical Center Waldo County Healthcare Southern Maine Healthcare MaineHealth
    21. 21. MaineHealth SDM Guiding Principle: Patients will engage in SDM to the extent that each patient desires.

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