1. Shared Decision Making An Overview of Knowledge, Policy and Quality Measurement Michael J. Barry, MD President March 2, 2011 Medical Directors Meeting

2. ABOUT US We Believe Patients Should Be Supported & encouraged to participate in their health care decisions Fully informed with accurate, unbiased & understandable information Respected by having their goals & concerns honored

3. State of our knowledge: the problem

4. Variation Picture Essentially Unchanged Medical Practice Variation 40 Years of Research Documenting Inconsistent Care

5. The DECISIONS Study A Portrait of How Americans Make Common Medical Decisions Mick Couper & Colleagues Institute for Social Research University of Michigan

6. The DECISIONS Study Telephone survey of a national, representative sample of 3,010 Americans age 40+ Surgery – Back surgery – knee/hip replacement – cataract extraction Cancer screening – Prostate – Colorectal – Breast Medications – Hypertension – Hyperlipidemia – Depression

7. What Have We Learned? Lack of balanced representation of risk (cons) Patient opinion often unacknowledged Physician recommendation trumps decision process Knowledge scores quite concerning

8. Poor Decision Quality Patients: Making Decisions in the Face of Avoidable Ignorance Clinicians: Poorly “Diagnosing” Patients’ Preferences

9. State of our knowledge: the solution

10. The Evidence Strengthens  SDM supported by patient decision aids improves decision quality  Both patients and physicians support SDM  Implementation models are demonstrating that SDM can work “in the trenches” O’Connor et al. Cochrane Database of Systematic Reviews, 2009

11. Funded Demonstration SitesPrimary CareSpecialty Care Massachusetts General HospitalX University of North CarolinaX Maine HealthX Mercy Clinics Inc.X Stillwater Medical GroupX Oregon Rural Practice Based Research NetworkX Palo Alto Medical Research FoundationX Group Health CooperativeXX University of WashingtonXX Allegheny General Hospital - Breast CenterX University of California San Francisco - Breast CenterX Dartmouth Hitchcock Medical Center (DHMC) - Breast CenterX DHMC - UrologyX DHMC - OrthopedicsX DHMC - Spine CenterX DHMC - CardiologyX

12. Policy Trends

13. Shared Decision Making Policy Adoption Trends

14. “As we have more and more evidence about how complex health and health care are, the need is growing exponentially for thoughtful, careful assessment by patients, working with their doctors and with access to evidence through shared decision making tools.” Alliance for Health Reform Capitol Hill Briefing on Shared Decision Making February 14, 2011 Helen Darling

15. Patient Protection and Affordable Care Act HR3590 Section 936 Program to Facilitate Shared Decision Making To facilitate collaborative process between patients and providers.. and to incorporate patient preferences and values into medical plan Authorized not Appropriated

16. Key Aspects of PPACA Section 936 1.Produce patient decision aids 2.Set quality standards and certify decision aids 3.Create Shared Decision Making Resource Centers 4.Grant funds to providers for development, use and assessment of SDM techniques using certified decision aids

17. Quality Measurement

18. Decision Quality Key Constructs: Patient knows there is a decision to be made Patient knows the reasonable options Patient learns about pros and cons of each option Patient goals and concerns are part of the decision process

19. Policy to Support Quality Standards Patient Centered Medical Home Medical “neighborhoods”/ACOs NQF Eight Priority Areas CAHPS Patient Decision Aid Certification Meaningful Use and HIT Leapfrog Group

20. The Role of Health Plans

21. For Consideration Support use of certified patient decision support tools Collaborate on quality measurement Create innovative benefit design to include shared decision making

22. Thank You! mbarry @ fimdm.org www.informedmedicaldecisions.org