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Patient-centered dissemination of
evidence-based medicine
A Journey Toward Shared Decision Making
Encounter Research
Weymiller et al. Arch Intern Med 2007
Statin Choice
Web
Compared to usual care,
patients using the decision aid were
22 times more likely
to have an accurate sense of their basel...
Osteoporosis Choice
Montori et al, AJM 2011
AMI Choice
Chest Pain Choice
Hess et al. Circ 2012
Mullan et al, Arch Intern Med 2009
Diabetes Medication Choice
Video / Web
Depression Medication Choice
LeBlanc 2012
Examples
Decision aid Evaluation
Risk communication tools
Statin Choice (primary care) Feasible, effective
Independently v...
The body of evidence
Systematic review of 115 RCTs
Compared to usual care, decision aids:
Increase patient involvement by ...
Summary of Mayo experience
Age: 40-92 (avg 65)
Primary care, ED, hospital, specialty care
74-90% clinicians want to use to...
Conclusions
• It is feasible to promote evidence-based
conversations during the clinical encounters
with patients with chr...
ShareEBM
Patient-centered dissemination of evidence-based medicine
http://www.share-ebm.org/
Mayo Clinic KER Unit (http://...
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  1. 1. Patient-centered dissemination of evidence-based medicine A Journey Toward Shared Decision Making
  2. 2. Encounter Research
  3. 3. Weymiller et al. Arch Intern Med 2007 Statin Choice Web
  4. 4. Compared to usual care, patients using the decision aid were 22 times more likely to have an accurate sense of their baseline risk and risk reduction with statins. Weymiller et al. Arch Intern Med 2007
  5. 5. Osteoporosis Choice Montori et al, AJM 2011
  6. 6. AMI Choice
  7. 7. Chest Pain Choice Hess et al. Circ 2012
  8. 8. Mullan et al, Arch Intern Med 2009 Diabetes Medication Choice Video / Web
  9. 9. Depression Medication Choice LeBlanc 2012
  10. 10. Examples Decision aid Evaluation Risk communication tools Statin Choice (primary care) Feasible, effective Independently validated Multicenter trial completed Implemented in EHR Chest pain Choice (emergency) Feasible, effective (Emergency) Multicenter trial seeking funding Aspirin Choice (primary care) Implemented in EHR without evaluation Osteoporosis Choice (primary care) Feasible, effective EHR implementation ongoing PCI Choice (cardiology) Ongoing AMI Choice (hospital) Feasible, effective (hospital) Issue cards DM2 Med Choice Feasible, effective Multicenter trial ongoing Implemented in EHR Depression Choice Ongoing
  11. 11. The body of evidence Systematic review of 115 RCTs Compared to usual care, decision aids: Increase patient involvement by 34% (+++-) Increase patient knowledge of options by 13% (++++) Increase consultation time by ~2.6 minutes Reduce decisional conflict by ~7% Reduce % undecided by 40% No consistent effect on choice, adherence, health outcomes or costs Stacey D et al. Cochrane review 2014
  12. 12. Summary of Mayo experience Age: 40-92 (avg 65) Primary care, ED, hospital, specialty care 74-90% clinicians want to use tools again Adds ~3 minutes to consultation 60% fidelity without training 20% improvement in patient knowledge 17% improvement in patient involvement Variable clinical outcomes
  13. 13. Conclusions • It is feasible to promote evidence-based conversations during the clinical encounters with patients with chronic conditions. • Decision aids designed for this purpose are efficient and effective in promoting shared decision making. • Tools tested in randomized trials and proven effective are available for free. • Partners to get to routine use in practice.
  14. 14. ShareEBM Patient-centered dissemination of evidence-based medicine http://www.share-ebm.org/ Mayo Clinic KER Unit (http://shareddecisions.mayoclinic.org) Institute for Clinical Systems Improvement (https://www.icsi.org/)

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