Shared Decision Making: Informed Patients Make Safer, More Cost-effective Choices
Patient engagement is defined differently by various clinicians, caregivers, health plans, and other providers. And healthcare organizations can have vastly divergent engagement goals. But one thing the majority of the healthcare industry can agree upon is that, whatever your strategy, patient engagement has three primary benefits that can improve both patient experience and healthcare business success:
- Enhanced patient satisfaction
- Improved treatment outcomes
- Improved financial and operational efficiency
Engagement hinges on shared decision-making (SDM), which is defined by the Office of the National Coordinator for Health IT (ONC) as “a process in which clinicians and patients work together to make decisions and select tests, treatments, and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.”
When there is more than one reasonable treatment option for patients to consider, it is up to providers and health plans to help patients weigh the benefits, risks, and potential impacts (physical, emotional, logistical, and financial) so that patients can make informed, confident decisions. Research has shown the effort is worthwhile:
- SDM can reduce preventable hospital readmissions by connecting patients to the most appropriate treatment the first time, according to a 2017 study
- A 2014 review found that surgery utilization can be reduced up to 20% when patients are actively engaged and involved in decision-making
- SDM can decrease patient anxiety about healthcare costs, notes a New England Journal of Medicine study
- Patients who opt out of expensive treatment options they don’t feel they need may be more likely to experience lasting results from their chosen treatments, says research from the Urban Institute
A key component of SDM is providing patients with decision aids – whether print, digital, multimedia, and/or interactive.
According to a 2012 Cochrane review study, patients who use decision aids more actively participate in their own health and decision-making. For participants in the randomized trials, this included:
- Improved knowledge of their treatment options
- More accurate expectations of potential benefits and risks of treatments
- Ability to make choices that aligned with their personal values
- Greater tendency to choose "conservative options" over elective surgery, with these options often including medication, physical therapy, and waiting
Other research bears out similar results. A 2013 study revealed that 58% of patients who viewed decisions aids were significantly more likely to reach an informed decision on their first provider visit, as opposed to only 33% of patients who had not viewed decision aids.
In 2012, Health Affairs published an article that examined the impact of decision aids in the specialty of orthopedic surgery at Group Health, a large health system in Washington State. The independent study yielded three key results over a six-month period among patients who viewed decision aids for hip and knee osteoarthritis:
- Knee replacement surgeries declined by 38%
- Hip replacement surgeries declined by 26%
- Costs declined by 12-21%
So, What’s the Problem?
As more and more research and case studies accumulate to demonstrate the positive impact of shared decision-making on patient experience, health outcomes, and healthcare spend, the question remains: Why isn’t it a more pervasive strategy in the industry?
One of the most significant barriers to more widespread adoption of shared decision-making strategies is awareness. Many healthcare organizations still aren’t that familiar with the options available to them in the market and how they might implement decision aids and SDM best practices into their workflows and practices.
It is also poses a potential demand on professionals’ time to add SDM to their already busy schedules. However, many advocates argue that the time and effort saved in better outcomes, improved patient experience, and potentially not needing to repeat or correct unsuccessful treatments is ultimately worth the extra time spent engaging with patients upfront.
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