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Patient Provider Decision Sharing: Better Decisions Together
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Patient Provider Decision Sharing: Better Decisions Together


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Nancy Rothman, a nursing professor at Temple University, describes the "Better Decisions Together" project aimed at engaging the chronically homeless and public housing residents in their health care …

Nancy Rothman, a nursing professor at Temple University, describes the "Better Decisions Together" project aimed at engaging the chronically homeless and public housing residents in their health care decisions.

This presentation was part of a Shared Decision Making Month webinar -- Shared Decision Making in the Real World: Stories from the Frontline.

Published in: Health & Medicine
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  • The impetus for the project from Ann Terragrossa the former admistrator for the Office of Heatlh Care Reform (Gov. Ed. Rendell) working with the Chronic Care Initiative.
  • For Foundation we were the first doing the SDM for this population. There has been skepticism that this tool and methodology would work in a population that was uninsured or medicaid population. (other than in privately insured population).
  • Why were interested in comparing out our site with other sites. Gender neutral topics allowed for a cleaner comparison.
  • Highlight the high percentage of patients who felt that they should have a very active role in making health care decisions.
  • We need to continue to make the argument to potential funders that this tool and methodology works in this population. There will be an upcoming site visit from Medicare Payment Advisory Commission to interview participants and providers.
  • Handouts for all of topicsHandout of all demonstration sitesPut web site for the foundation
  • Transcript

    • 1. Nancy Rothman, RN, EdDIndependence Foundation Professor of Urban Community NursingDepartment of Nursing, College of Health Professions and Social WorkWebinar March 6, 2013
    • 2.  National Nursing Centers Consortium Informed Medical Decisions Foundation Pennsylvania Governor’s Office of Healthcare Reform Public Health Management Corporation Temple University
    • 3. 2009 2010 2011 and 2012 Decision aids viewed in•Ann Torregrossa, •Local planning and implementation of project at centers (Director of PA Governor’s 5 nurse practitioner practices Or sent home ( to mail back)Office of Health Care Reform) ( all were participating in the Governor’s•Nancy Rothman Chronic Care Initiative) Referral sheet faxed from centers•Seek support from the Decision aids viewed in centers •Patient name and contactInformed Medical Decisions Foundation Or sent home ( to mail back) informationand Health Dialogue for: •Name of decision aid(s) Referral sheet faxed from centers •Permission to contact•Supply of decision aids •Patient name and contact information patient •Name of decision aid(s)•Support for project from Foundation •Permission to contact patient •Pre-viewing surveysStaff •Post-viewing surveys•Richard Wexler, MD •Pre-viewing surveysDirector of Patient Support Strategies •Post-viewing surveys Coaching by on-site• Kate Clay, MA, BSN, RN RN Care ManagersOffice of Professional Education and Follow-up with a nurse practitionerOutreach •In personThe Dartmouth Institute of Health Policy •In person •By phoneand Clinical Practice •By phone •Answer questions •Answer questions •Clarify values related to •Clarify values related to decision decision •Help support a decision related plan •Help support a decision related plan
    • 4.  Chronically Homeless Public Housing Residents 20%-40% Uninsured 75%-55% Medicaid 5% Medicare or Private Insurance
    • 5. •Posters were placed in the waiting rooms as well as other locations in all of the participating clinics.•Corresponding brochures with a short description of each decision aid were provided to be handed out either in the waiting room or by providers in the exam rooms.•Decision aids have been added.
    • 6. BPH 2BUCA 1 CLBP 9 CPM 2 DEP 4 DIA 35 HIP 2 KOA 4MENO 5 PCA 1 PSA 9 WLS 4 0 5 10 15 20 25 30 35 40
    • 7. 100% 90%80% 78% 80% 76%60% 64% 59%40% 47% 43% 35%20% 0% 5% Female HS Grad or Less Under Age 60 Not Hispanic Black, Bothered "A Lot"  Temple (n=60)  Other Demo Sites (n ≈ 2256)
    • 8. 100%80% 86% 74% 71%60% 63% 57%40% 46% 43%20% 15% 0% Taking Taking Taking Smoke Blood Sugar Cholesterol Blood Pressure Cigarettes Meds Meds Meds  Temple (n=35)  Other Demo Sites (n=292)
    • 9. 100%80% 86% 74% 71%60% 63% 57%40% 46%20% 0% Cholesterol Blood Pressure Meds Meds
    • 10. 100%80%60% 66% 50% 50%40% 39% 41% 34% 32% 32%20% 0%Losing More Physical Activity Weight Healthy Seeing Diet Eye Doctor  Other Demo Sites (n=292)  Temple (n=35)
    • 11.  There was limited data available on multiple decision aides (n=80) from the pilot project (2011). However, the findings included: 78 of patients watched DVD exclusively, but did not read accompanying book. 87% of patients believed prior to watching a DVD decision aid that decisions about their care should be made by themselves and their provider together. This finding raises the importance of patients having the knowledge they need to participate in decisions regarding their health care. This is especially true in the safety net population, with low literacy and numeracy, being served by the involved clinics. 92% of patients believed, after watching the DVD decision aid that decisions about their care should be made by themselves and their provider together; 8% indicated they alone should make decisions about their care.
    • 12.  View decision aids as a value added service Working to further integrate the shared decision process into the normal care processes within the clinics ◦ Assigning staff responsibility in job descriptions Primary health care practice ownership so that upstream decision- making can be optimally supported
    • 13.  “It gives the patients opportunity to discuss the conditions fully with their provider”. “For the provider, it gives us time to engage the patients in their care”. “The DVDs give patients a better understanding of what their options are”. “Patients can review them multiple times and share them with family members”. “The patients feel that they are making decisions based on unbiased facts”. “Patients hear about how other people have approached similar decisions and whether they felt satisfied with the outcomes of their choices”.
    • 14. rothman@temple.edu