Wednesday, 30 January 2013

Shared Decision Making to Improve Care and Reduce Costs

I have just been reading this editorial by Lee and Emanuel, which makes the point that randomised trials have consistently demonstrated the effectiveness of patient decision aids. In 2011, a Cochrane collaborative review of 86 studies showed that, compared with patients who used usual care, those that used decision aids had increased knowledge, more accurate risk perceptions, reduced internal conflict about decisions and a greater likelihood of receiving care aligned to their values. Moreover, fewer patients were undecided or passive in the decision making process- changes that are essential for patients’ adherence to therapies.

The authors note that progress in embedding shared decision making into routine care has been slow, despite the recommendation of the Institute of Medicine about SDM in the seminal publication "Crossing the Quality Chasm"  back in 2001.

The New England Journal of Medicine editorial, and you don’t get more influential than that, points out that studies in the USA also illustrate the potential for wider adoption of shared decision-making to reduce costs. Consistently, as many as 20% of patients who participate in shared decision making choose less invasive surgically options and more conservative treatment, than patients that do not use decision aids.

The authors suggest that providers who do not document shared decision making processes for preference sensitive health care choices about procedures, should face a 10% reduction in payments for those procedures with reductions in payment gradually increase to 20% over 10 years. It will be interesting to read the letters page of the NEJM next week!!

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