Shared decision making is an important component of quality medical care. The use of decision aids in clinical practice increases shared decision making and improves care. However, implementation of decision aids in primary care can be difficult because of multiple barriers including time restraints and a hectic clinical environment. Unfortunately, the current standard for decision support for most primary care practices ranges from unsystematic at best to non-existent at worst. The few existing programs often rely on physician referrals or patient requests which are not systematic and may not reach the patients most likely to benefit from decision support. Based on our previous work, we conclude that to sustainably deliver decision aids will require a system that ties distribution to an upcoming visit, automates as much of the delivery process as possible, and then implements changes that alter staff work flow to assure delivery. The design of the Patient Decision Quality Initiative is to combine improved information technology in our practice to appropriately distribute decision aids to patients with Continuous Quality Improvement techniques to facilitate systematic staff delivery of decision aids to all of our patients who might benefit from decision support using an automated Decision Aid Delivery System. The overarching goal of the Patient Decision Quality Initiative is to improve the quality of care using decision support to promote shared decision making. Our vision for the Patient Decision Quality Initiative is to deliver appropriate decision aids to all eligible patients all of the time. To achieve our vision, we will build on our successful quality improvement program for chronic conditions (diabetes, heart failure, pain, anticoagulation) through the following objectives: 1) We will first develop and refine a systematic decision aid delivery system in one of our four clinic teams. 2) We will expand this system to the three remaining teams within the practice using CQI techniques.
Principal Investigator: Carmen Lewis, M.D., M.P.H.
Funding Source: Foundation for Informed Medical Decision Making
Total Project Period: 7/1/09 – 6/30/13