SlideShare a Scribd company logo
How to Improve the Quality of Medical Decisions The 11 th  Population Health and Care Coordination Colloquium March 15, 2011 Michael J. Barry, MD Foundation President
Foundation Mission ,[object Object],[object Object]
ABOUT US We Believe Patients Should Be
The Foundation and Health Dialog The licensing agreement between the Foundation and Health Dialog, its production and distribution partner, provides royalties as well as contract funding to develop and maintain Shared Decision-Making Programs and other decision support materials. Staff of the Foundation and all Medical Editors must adhere to a stringent conflict-of-interest policy that prohibits financial support from the drug and device industries, and requires disclosure of any relationships with professional societies or health plans.
Is Informed Consent “Real”? ,[object Object],[object Object],[object Object],[object Object],[object Object],(Holmboe ES.  JGIM 2000;  15:632)
Is Informed Consent “Real”? ,[object Object],[object Object],(Trikalinos TA.  Lancet 2009;  373:911)
Is Informed Consent “Real”…10 years later? ,[object Object],[object Object],[object Object],(Rothberg MB.  Annals Intern Med 2010;  153:307)
DECISIONS Survey ,[object Object],[object Object],[object Object],[object Object],[object Object],(The Decisions Study. Medical Decision Making 2010;  30 supplement 1)
DECISIONS Survey: Decisions Addressed ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epidemiology of Medical Decisions in US ,[object Object],[object Object],[object Object],[object Object]
Discussion of Pros versus Cons
Clinician Opinions versus Asking Patient
How Much did Patients Know ? ,[object Object],[object Object],[object Object]
U.S. CABG rates
Poor Decision Quality Patients:  Making Decisions in the  Face of Avoidable Ignorance Clinicians:  Poorly “Diagnosing” Patients’ Preferences
Decision Quality: Key Constructs ,[object Object],[object Object],[object Object],[object Object]
What is Good Medical Care? ,[object Object],[object Object]
Shared Decision-Making Model ,[object Object],[object Object],[object Object],[object Object],[object Object],(Charles C, Soc Sci Med 1997;  44:681)
[object Object],[object Object],[object Object],Patient Decision Aids Can Help! (The International Patient Decision Aid Standards Collaboration )
[object Object],[object Object],[object Object],Patient Decision Aids Can Help! (The International Patient Decision Aid Standards Collaboration )
The Evidence Strengthens ,[object Object],[object Object],[object Object],O’Connor et al.  Cochrane Database of  Systematic Reviews, 2009
Cochrane Review of Decision Aids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(O’Connor et al. Cochrane Database of Systematic Reviews  2009, Issue 3. Art. No.: CD001431 )
Funded Demonstration Sites Primary Care Specialty Care Massachusetts General Hospital X University  of  North Carolina X Maine Health X Mercy Clinics Inc.  X Stillwater Medical Group X Oregon Rural Practice Based Research Network X Palo Alto Medical Research Foundation X Group Health Cooperative X X University of Washington X X Allegheny General Hospital  - Breast Center X University of California San Francisco - Breast Center X Dartmouth Hitchcock Medical Center (DHMC) - Breast Center X DHMC - Urology X DHMC - Orthopedics X DHMC - Spine Center X DHMC - Cardiology X
Shared Decision Making Policy Adoption Trends
[object Object],[object Object],[object Object],[object Object],[object Object],SDM: Implementation Needs
Thank You! mbarry @ fimdm.org www.informedmedicaldecisions.org

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How to Improve the Quality of Medical Decisions

  • 1. How to Improve the Quality of Medical Decisions The 11 th Population Health and Care Coordination Colloquium March 15, 2011 Michael J. Barry, MD Foundation President
  • 2.
  • 3. ABOUT US We Believe Patients Should Be
  • 4. The Foundation and Health Dialog The licensing agreement between the Foundation and Health Dialog, its production and distribution partner, provides royalties as well as contract funding to develop and maintain Shared Decision-Making Programs and other decision support materials. Staff of the Foundation and all Medical Editors must adhere to a stringent conflict-of-interest policy that prohibits financial support from the drug and device industries, and requires disclosure of any relationships with professional societies or health plans.
  • 5.
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  • 11. Discussion of Pros versus Cons
  • 12. Clinician Opinions versus Asking Patient
  • 13.
  • 15. Poor Decision Quality Patients: Making Decisions in the Face of Avoidable Ignorance Clinicians: Poorly “Diagnosing” Patients’ Preferences
  • 16.
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  • 23. Funded Demonstration Sites Primary Care Specialty Care Massachusetts General Hospital X University of North Carolina X Maine Health X Mercy Clinics Inc. X Stillwater Medical Group X Oregon Rural Practice Based Research Network X Palo Alto Medical Research Foundation X Group Health Cooperative X X University of Washington X X Allegheny General Hospital - Breast Center X University of California San Francisco - Breast Center X Dartmouth Hitchcock Medical Center (DHMC) - Breast Center X DHMC - Urology X DHMC - Orthopedics X DHMC - Spine Center X DHMC - Cardiology X
  • 24. Shared Decision Making Policy Adoption Trends
  • 25.
  • 26. Thank You! mbarry @ fimdm.org www.informedmedicaldecisions.org