Decision Aids Enhancing the Patient Experience Annie LeBlanc PhD Wiser Choices Program Knowledge and Evaluation Research Unit.

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Presentation transcript:

Decision Aids Enhancing the Patient Experience Annie LeBlanc PhD Wiser Choices Program Knowledge and Evaluation Research Unit

Disclosures Relevant Financial Relationships None Off Label Usage None

Our Decision Aids are focused on facilitating a conversation between health professionals and patients and thus designed as tools intended for use during the clinical encounter

Evidence synthesis Observations clinical encounter Designers Study team Patients advisory groups Clinicians Stakeholders Initial prototype Field testing Modified prototype Final Decision Aid

The Wiser Choices Program Statin Choice Decision aid

Acceptable to patients (OR 2.8) Improved knowledge (2.4/9) Improved risk estimation (OR 22) Decreased decisional conflict (11/100) Improved total trust (OR 2.6) Improved action (70% fewer Rx in low risk patients) Short-term adherence (OR 3.4) Weymiller et al. Arch Intern Med 2007

The Wiser Choices Program Aspirin Choice Decision aid

The Wiser Choices Program Osteoporosis Choice

Just as acceptable as usual care >75% MDs found helpful (+ 1 min to consultation) Improved knowledge (1.8/9) Improved risk estimation (~RR 2) No change in decisional conflict or trust Increased patient participation in choice (9%) Same rate of Rx (~50%) in low and high risk patients Adherence evaluation is pending Montori VM et al. Submitted

The Wiser Choices Program Diabetes Medication Choice Decision Aid

Glucose control in t2 diabetes No clear evidence for a goal HbA1c Comparative effectiveness data of safety 9 types of agents (+ lifestyle modification) Many attributes per agent

Mullan RJ et al. Archives of Internal Medicine 2009 more helpful (AMD 0.38; 95%CI, ) improved knowledge (AMD 1.10; 95%CI, ); and had more involvement in making decisions (AMD 21.8; 95%CI, ) 6-mo perfect medication use (100% of days covered) better adherence (AMD, 9% more days covered; 95%CI, 4%-14%) persistence (AMD, 12 more days covered; 95% CI, 3-21 days) no significant impact on HbA1c levels (AMD, 0.01; 95%CI, −0.49 to 0.50)

Interactive Diabetes Cards

The Wiser Choices Program Other Wiser Choices Decision aids

Chronic care Depression Choice (AHRQ) Genomic Cardiovasular Choice Hypertension Rosiglitazone (Avandia)

Acute care Chest Pain Choice AMI Choice Periop Smoking

13 Wiser Choices Decision aids Chronic & acute care Primary care & subspecialty & ER In/out patient settings Rural & urban communities >50 sites > 200 clinicians > 600 patients

Shared Decision Making National Resource Center Wiser Choices Program Knowledge and Evaluation Research Unit

Contributions Patient Protection and Affordable Care Act Develop & evaluate patient decision aids Define international standards Educate and train care providers Adopt and use decision aids at point of care Contribute to statewide implementation efforts

Internal Partners SDMNR Center One Voice Health Policy Center Center for Social Media Dept. of Development Center for Innovation Wiser Choices Program Patient Education Center MayoClinic. com Program in Prof. & Ethics AskMayo Expert

Center Website Blog Announcements (events) Resources Research News articles

Creating a conversation Evidence synthesis Translation of evidence into action Patient important research Design of care around the needs of the patient Improve value of healthcare to the patient Minimally disruptive medicine FIT Shared decision making