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.

1. Nancy Rothman, RN, EdD
Independence Foundation Professor of Urban Community Nursing
Department of Nursing, College of Health Professions and Social Work
Webinar 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 contact
Informed Medical Decisions Foundation Or sent home ( to mail back) information
and 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 surveys
Staff
•Post-viewing surveys
•Richard Wexler, MD •Pre-viewing surveys
Director of Patient Support Strategies •Post-viewing surveys Coaching by on-site
• Kate Clay, MA, BSN, RN
RN Care Managers
Office of Professional Education and Follow-up with a nurse practitioner
Outreach
•In person
The Dartmouth Institute of Health Policy •In person •By phone
and 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 2
BUCA 1
CLBP 9
CPM 2
DEP 4
DIA 35
HIP 2
KOA 4
MENO 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
http://informedmedicaldecisions.org