Enhanced Support For Shared Decision Making Reduced Costs Of Care For Patients With Preference-Sensitive Conditions

Abstract

Shared decision making is an approach to care that seeks to fully inform patients about the risks and benefits of available treatments and engage them as participants in decisions about the treatments. Although recent federal and state policies pursue the expanded use of shared decision making as a way to improve care quality and patient experience, payers and providers want evidence that this emerging model of care is cost-effective. We examined data obtained from a year-long randomized investigation. The study compared the effects on patients of receiving a usual level of support in making a medical treatment decision with the effects of receiving enhanced support, which included more contact with trained health coaches through telephone, mail, e-mail, and the Internet. We found that patients who received enhanced support had 5.3 percent lower overall medical costs than patients who received the usual level of support. The enhanced-support group had 12.5 percent fewer hospital admissions than the usual-support group, and 9.9 percent fewer preference-sensitive surgeries, including 20.9 percent fewer preference-sensitive heart surgeries. These findings indicate that support for shared decision making can generate savings. They also suggest that a "remote" model of support-combining telephonic coaching with decision aids, for example-may constitute a relatively low-cost and effective intervention that could reach broader populations without the need for the direct involvement of regular medical care team members.

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

“…Direct financial incentives to support SDM are currently uncommon, 121,122 but interest in providing these incentives is growing as patient-centered care becomes a standard component of high-quality care. For example, some payers have experimented with incentives for SDM in demonstration projects, 8 and the Center for Medicare and Medicaid Innovation has funded SDM as part of its advanced primary care initiatives and included multiple SDM projects in their health care innovation award portfolio.…”

Analysis and design of mobile health interventions towards informed shared decision making: an activity theory-driven perspective

“…Shared decision making is an approach where patients and clinicians jointly make decisions based on best available evidence as well as patients' preferences and values (Veroff et al, 2013). Patients are engaged in considering their options, benefits, and risks in various healthcare processes such as screening, treatment, or management (G. Elwyn et al, 2010).…”

“…For instance, patients with schizophrenia, those who participated in a printed decision aid, obtained better knowledge about their conditions and had elevated perceived involvement in health decisions (Hamann et al, 2006). There are also multiple evidence that shared decision making for preference-sensitive conditions (e.g., back pain, early breast/prostate cancer, and angina) leading to reduced rates of surgery, lesser nonsurgical admissions, and cost savings (Stacey et al, 2014;Veroff et al, 2013;Wennberg, Fisher, & Skinner, 2002). Towle and Godolphin (1999) clearly describe "informed shared decision making" as an interactive process where the connection between the informed patient and the informed clinician plays a critical role in achieving informed preferences.…”

“…Shared decision making, which has been long regarded as a model for clinical practice to achieve informed decisions (Veroff, Marr, & Wennberg, 2013), is also an imperative part of mobile health's digital revolution. Mobile health interventions are capable of sharing best available evidence, handling patients' values and preferences, as well as promoting continuous cooperation between clinicians and patients to make decisions jointly and remotely.…”

Ten clinician-driven strategies for maximising value of Australian health care

“…70 In another study, shared decision making across a range of conditions facilitated by regular contact with trained health coaches resulted in 13% fewer hospital admissions, 10% reduction in preference-sensitive surgeries and 5% lower overall medical costs compared with usual care. 71 Patients with chronic diseases, such as diabetes, heart failure and asthma, and who are poorly 'activated' (i.e. lacking skills and confidence in managing their own diseases) demonstrate worse outcomes at higher cost 72 (up to 12% higher per capita cost 73 ) than those who are highly activated, after adjusting for demographic characteristics and illness severity.…”