Enrollees Choose Priorities for Medicare

Danis, Marion; Biddle, Andrea K.; Goold, Susan Dorr

doi:10.1093/geront/44.1.58

Cited by 19 publications

(15 citation statements)

References 47 publications

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“…Importantly, views of the discussions, which included their perceptions of respectful treatment, equal opportunity to talk and civility, were the strongest predictor of trust in the process and support for using results to inform decision makers. This suggests that participants viewed this as a fair process for decision making, a finding consistent with similar projects …”

Section: Discussionsupporting

confidence: 79%

Evaluating community deliberations about health research priorities

Goold¹,

Danis

Abelson

et al. 2019

Health Expectations

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Context Engaging underrepresented communities in health research priority setting could make the scientific agenda more equitable and more responsive to their needs. Objective Evaluate democratic deliberations engaging minority and underserved communities in setting health research priorities. Methods Participants from underrepresented communities throughout Michigan (47 groups, n = 519) engaged in structured deliberations about health research priorities in professionally facilitated groups. We evaluated some aspects of the structure, process, and outcomes of deliberations, including representation, equality of participation, participants’ views of deliberations, and the impact of group deliberations on individual participants’ knowledge, attitudes, and points of view. Follow‐up interviews elicited richer descriptions of these and also explored later effects on deliberators. Results Deliberators (age 18‐88 years) overrepresented minority groups. Participation in discussions was well distributed. Deliberators improved their knowledge about disparities, but not about health research. Participants, on average, supported using their group's decision to inform decision makers and would trust a process like this to inform funding decisions. Views of deliberations were the strongest predictor of these outcomes. Follow‐up interviews revealed deliberators were particularly struck by their experience hearing and understanding other points of view, sometimes surprised at the group's ability to reach agreement, and occasionally activated to volunteer or advocate. Conclusions Deliberations using a structured group exercise to engage minority and underserved community members in setting health research priorities met some important criteria for a fair, credible process that could inform policy. Deliberations appeared to change some opinions, improved some knowledge, and were judged by participants worth using to inform policymakers.

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Section: Discussionsupporting

confidence: 79%

Evaluating community deliberations about health research priorities

Goold¹,

Danis

Abelson

et al. 2019

Health Expectations

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“…Fair guidelines could be developed by having communities conduct deliberative procedures for deciding what probability of benefit is low enough to forgo treatment. Participants in a priority setting exercise in the USA were able to understand the need for priority setting and were willing to trade off intensive care for the sake of other services and would accept a threshold probability of survival at which they would want intensive care [27]. On the other hand, it may be that some of these differences are deeply rooted in cultural views and traditions, in which case it is valuable to identify these areas of possible intractable disagreement.…”

Section: Discussionmentioning

confidence: 99%

Triage of intensive care patients: identifying agreement and controversy

et al. 2013

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Rationale Intensive care unit (ICU) resources are limited in many hospitals. Patients with little likelihood of surviving are often admitted to ICUs. Others who might benefit from ICU are not admitted. Objective To provide an updated consensus statement on the principles and recommendations for the triage of patients for ICU beds. Design The previous Society of Critical Care Medicine (SCCM) consensus statement was used to develop drafts of general and specific principles and recommendations. Investigators and consultants were sent the statements and responded with their agreement or disagreement. Setting The Eldicus project (triage decision making for the elderly in European intensive care units). Participants Eldicus investigators, consultants, and experts consisting of intensivists, users of ICU services, ethicists, administrators, and public policy officials. Interventions Consensus development was used to grade the statements and recommendations. Measurements and main results Consensus was defined as 80 % agreement or more. Consensus was obtained for 54 (87 %) of 62 statements including all (19) general principles, 31 (86 %) of the specific principles, and 10 (71 %) of the recommendations. Inconsistencies in responses were noted for ICU admission and discharge. Despite agreement for guidelines applying to individual patients and an objective triage score, there was no agreement for a survival cutoff for triage, not even for a chance of survival of 0.1 %. Conclusions Consensus was reached for most general and specific ICU triage principles and recommendations. Further debate and discussion should help resolve the remaining discrepancies.

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“…The first research project that was conducted in North Carolina examined the insurance preferences of several populations, including low-income uninsured individuals (Danis et al, 2002) and the elderly Medicare population (Danis et al, 2004), and evaluated the exercise from the perspective of participants (Goold et al, 2005). As awareness of the exercise has grown, a number of foundations have sponsored the use of CHAT.…”

Section: Use Of the Chat Exercise In The United Statesmentioning

confidence: 99%

Experience in the United States With Public Deliberation About Health Insurance Benefits Using the Small Group Decision Exercise, CHAT

Danis

Ginsburg

Goold

2010

Journal of Ambulatory Care Management

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“Choosing Healthplans All Together”(CHAT) is a small group decision exercise designed to give the public a voice in priority setting in the face of unsustainable health care costs. It has been used for research, policy, and teaching purposes. Departments of insurance in various states in the United States have used CHAT to determine public opinion about what should be included in basic health insurance packages for the uninsured. Some municipalities have used it to assess public priorities for direct service delivery to the uninsured. Setting up the exercise requires substantial preparation, but the public finds it simple to use and understand.

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Enrollees Choose Priorities for Medicare

Cited by 19 publications

References 47 publications

Evaluating community deliberations about health research priorities

Evaluating community deliberations about health research priorities

Triage of intensive care patients: identifying agreement and controversy

Experience in the United States With Public Deliberation About Health Insurance Benefits Using the Small Group Decision Exercise, CHAT

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