Tools to enable shared-decision making : An integrated approach - Bupa Health Dialog - Dr Henriette Coetzer Vice President and Medical Director ...
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Bupa Health Dialog Tools to enable shared-decision making : An integrated approach Dr Henriette Coetzer Vice President and Medical Director, Global
The NHS Population and decision making A preview of the Bupa Ipsos-Mori Survey results on SDM Bupa commissioned Ipsos MORI to survey 1001 people in the UK in July 2010 about their views on a variety of issues in healthcare. The first round of results, which focused on ageing, are available at http://www.bupa.com/mediacentre/healthpulse Bupa Health Dialog
The Care you need and no less,
the care you want and no more ?
For at least 70%of
people who have heart
bypass surgery, the
survival rate is no better
In many people with
than if they had chosen
stable heart disease,
to take medication
medications are just as
alone
good as stents or bypass
surgery at lowering the
chance of heart attack.
Fewer than one in five
was asked by their
health care provider
about their preferences
for care.
Less than 50%were
able to answer basic
questions about their
condition and its
treatment
Bupa Health Dialog
Key differences exist between the focus of providers and that of patients - both in terms of what the key information is and what patients care about most • 46 to 86 percent of patients (with the exact proportion varying by condition) rank “doing what the doctor thinks is best” as a high priority, whereas only 5 to 40 percent of providers feel similarly. • The way in which the information is presented can have important impacts on how it is processed. Bupa Health Dialog
The collaboration between doctors and patients can be
improved
What matters most depends on who you ask
Q: Did your provider discuss pros & cons “some” or “a lot”?
0 20% 40% 60% 80% 100%
Elective surgery:
Lower back pain 72%
62%
Knee/hip replacement 90%
49%
Cataract 76%
33%
Cancer screening:
Prostate cancer (men) 69%
16%
Colon cancer 73%
14%
Breast cancer (women) 75%
13%
Discussed pros Discussed cons
Bupa Health Dialog
Couper M. DECISIONS Survey, 2009
Preference-Sensitive Care Differences in choice dynamics lead to variation –often unwarranted “There is no excuse for avoidable ignorance” –Al Mulley Bupa Health Dialog
What matters most depends on who you ask and
how roles are perceived
Q: Is doing what the doctor thinks best a top priority?
% of patients who % doctors who say
Decision
say top 3 priority top 3 priority
Breast cancer surgery 86% 14%
Hip replacement 84% 40%
Knee replacement 78% 35%
Spinal stenosis 46% 5%
Sources: Sepucha K, et al. Patient Education and Counseling 2008 and Lee et al. 30th
Bupa Health Dialog
Annual Society for Medical Decision Making Conference, Philadelphia, 2008.
“Evidence doesn’t make decisions, people do…” Guyatt Improving decision quality Decision quality is defined as the extent to which treatment reflects the informed preferences of patients and is implemented. It describes the agreement between what a well-informed patient really wants and the treatment he or she actually gets. Shared Decision Making is a collaborative effort between physician and patient, who share information, preferences, and concerns as they negotiate a course of action (Charles, Gafni and Whelan) Bupa Health Dialog
Decision Quality through SDM -
Integrated tools and approaches
Identify the target population Support the decision
Provide ongoing support
at the optimal time effectively
Decisions are time-sensitive, Supporting decisions in Decisions are not one-time
transitions in care have to be context is critical. events. Health and care is a
anticipated to identify continuum of decisions.
Decision Aids need to be
decision-windows and to
evidence-based and
allocate resources effectively
accessible.
Decision Aids and
Predictive Modelling Specialised coaching Health Coaching
Support the doctor-patient relationship and
system goals
Value-aligned care Better quality care Better health and
well-being outcomes
Bupa Health Dialog
9
Care Pathway based variation analysis : A predictive Data
Model in the NHS
The ability to integrate data along the care continuum is critical to evaluate the potential impact of Shared
Decision Making in different delivery and infrastructure systems.
HD Integrated
Risk Model
Outpatient
Data
Speciality
Procedure
GP Data Referral
Diagnosis
Analgesics
Inpatient Data
Frequency
Procedures
Bupa Health DialogIt is also possible to assign people to stages in their clinical journey to present the information to support their key decisions at that time Bupa Health Dialog
Print, Web, and video tools reinforce the message
Print Web Video
• Evidence-based material • Evidence-based info about • Library of videos (VHS &
printed from Healthwise® conditions and treatment DVD) and print material
Knowledgebase options available through providing evidence-based
the Web information
• Pamphlets and fact sheets
from nationally recognized • PHR, a single place to keep • Understand key treatment
organizations such as the personal health information decisions from the
ADA or NIH physician’s and patient’s
• Health Crossroads®
perspective
• Available at various reading provides simple navigation
levels and in Spanish for through difficult decisions • Overview of the available
many topics treatment options and
implications of each
Bupa Health DialogShared Decision Making
Reduces utilisation and medical costs
Medicare Surgery Rates for Hip and Knee
Rate per 1 0 0 ,000 Members
Program
Start
Surgery rates falling faster than national benchmarks
(Medicare and National Hospital Discharge Survey)
Bupa Health DialogThere are a number of key imperatives in order to successfully
introduce Shared Decision Making in the NHS
Identification – Availability, reliability and modeling of data
and targeting
Competencies – Structured interaction
and Capabilities
Quality Material – Consistent, effective, evidence-based and
localised Decision Aids
– Recognising that care is a continuum of
Ongoing
Support challenges and decisions
Bupa Health Dialog
14Tools to enable Tools to enable shared-decision making : shared-decision making : An integrated approach An integrated approach Dr Henriette Coetzer Vice President and Medical Director, Global Bupa Health Dialog
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