Putting the Patient First—Shared Decision Making at Kaiser Permanente

Abstracts from the Kaiser Permanente2018 National Quality Conference

 

Andrew Felcher, MD; Matt Handley, MD

https://doi.org/10.7812/TPP/18-071-31

From Colorado, Georgia, Hawaii, Northern California, Northwest, Southern California, Washington, Program Offices

Background: Shared decision making (SDM) promotes personalized care that supports patients’ values. Successful implementation of SDM furthers the Quadruple Aim, augments care delivery, and accelerates implementation of evidence-based practices. Good SDM programs use high-quality decision aids and point-of-care conversation aids, train physicians in SDM conversations, and measure effects on both patient and clinician satisfaction, resource use, and clinical outcomes. Current adoption of SDM varies by Kaiser Permanente (KP) Region and topic.
Methods: We present a few key studies of SDM programs that assess SDM aid use, including patient and provider satisfaction, referral counts, and provider time spent, and compare them with usual care, such as patient education booklets, in common preference-sensitive conditions such as back surgery. The programs include both patient decision aids and point-of-care conversation aids.
Results: SDM has been demonstrated to improve patient choices, provide a positive effective on patient-provider communication, and improve knowledge of and perception of outcomes with no adverse effect on health outcomes. SDM has received increasing attention from legislators and policy makers. In Regions where SDM aids and clinician training were readily available, use of the aids increased over time, and they have been favorably received with provider and patient satisfaction > 70%. However, KP still uses a variety of vendors and tools, and frontline providers may not understand SDM—many believe they are already engaging in SDM conversations. KP has not historically used a standard framework to evaluate SDM programs and aids. KP is actively developing new SDM topics and converging on high-quality aids, tools, and training.
Discussion: In this session, participants will learn how SDM is personalizing care delivery to help make informed decisions; how we are incorporating evidence-based clinical information and making it accurate and readily available to clinicians and patients at point of care; and how SDM benefits our patients, is doable at the point of care, saves time, and leads to better outcomes. For patients, previsit decision aids provide valuable information to patients and improve SDM. For providers and patients, we hypothesize that the most valuable SDM tools are embedded in the electronic medical record, are easily accessible, show clear risks and benefits, and are displayed in a patient-friendly format. We will be seeking audience input into the design of KP’s programwide SDM efforts as well as helping the audience learn about SDM in their Regions and practices. Our hope is that participants will adopt and reliably use the aids and SDM methods showcased.

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