Implementing Shared Decision Making on a Large Scale: Through Specialty Care
To view the latest published results on the Group Health Cooperative decision aids implementation effort, click here. David Arterburn is Lead Author on the study.
Group Health implemented decision aids on a large scale in an unusual way: through working directly with specialty care providers and their staff.
In 2009, as part of a quality-improvement program, Group Health leaders, providers, and staff started to implement 12 decision aids in six specialties: orthopedics, cardiology, urology, women’s health, breast cancer, and back care. Each of these decision aids is for patients at a crossroad: deciding whether to have an elective surgical procedure.
At first thought, primary care seemed like the ideal place for Group Health to implement decision aids to support shared decision making in many of these areas. But at that time, Group Health was going through a major overhaul of its primary-care clinics, transforming them into patient-centered medical homes. Since the primary-care providers and staff were already so busy with that change, decision-aid implementation focused instead in specialty care.
That specialty-oriented implementation has worked out really well. More decision aids have been distributed at Group Health than at any other single health care organization in the world: more than 25,000 by July 2012, with around 900 more per month.
Each leader, provider, and staff member in those six specialty services at Group Health has seen the decision aids that their service is using. The engagement of Group Health leadership and providers is leading to large-scale culture change around the use of decision aids for preference-sensitive care and shared decision making. Group Health’s culture of care has become even more centered on the individual patient. None of this could have happened without the whole-hearted enthusiasm of Group Health leadership.
At Group Health, a decision aid is ordered whenever a patient with any of the 12 relevant conditions makes an appointment to see a specialty provider or receives a new relevant diagnosis in one of the six specialties. Patients can watch the videos alone or with their families either on a DVD that is mailed to them or online on Group Health’s secure website for patients.
Our research is exploring how using decision aids in routine practice can affect health care and costs. As we’ve evaluated the implementation, Group Health specialists have told us that the decision aids help to prepare the patients, informing them about potential risks and benefits of different treatment options. That means that during the office visit, patients can go straight to the heart of what matters to them most as individuals. So the provider-patient conversations end up being more personally meaningful for the patients—and less generic.
Now that Group Health providers and staff in the specialty services are “on board” with the decision aids—and the medical home transformation is done—decision aid implementation is now moving further upstream, from specialty care into primary care. We envision a future where most major elective surgical decisions are taking place in a patient’s medical home, where primary care providers and specialists are working together with their patients to help them take their own personal preferences and goals into consideration, and make the right choices at the right time.
David E. Arterburn, MD, MPH, is a general internist and associate investigator at Group Health Research Institute. He is also an affiliate associate professor of medicine at the University of Washington School of Medicine.