Metrics on Shared Decision Making

There is also ongoing discussion about the best metrics to assess the shared decision making process (Agency for Healthcare Research and Quality, 2015). Much of this discussion focuses on practical matters (i.e. provider level vs. patient level tracking of shared decision making, all or none measures, tracking of orders for a decision aid versus actual use, which patient-reported outcomes can reflect shared decision making). Table 2 provides example quality metrics from national surveys generally accepted to capture shared decision making and example process measures used by implementing health systems (i.e. Group Health, Harvard).

Many systems are focusing instead on tracking preference-sensitive conditions. “Preference-sensitive care” refers to situations where outcomes are similar for different options but the harms and benefits that may occur along the way are not (e.g. survival is similar for treatment of early local breast cancer with lumpectomy or mastectomy, but there are differing harms and benefits to each option). Other examples of preference-sensitive decisions include treatment for early prostate cancer, abnormal uterine bleeding, low back pain, colon cancer screening, and joint replacement surgery. Shared decision making and the use of decision support tools are well suited to addressing the unwarranted variation in our health care system that arises with preference-sensitive conditions (O’Connor, Llewellyn-Thomas, & Flood, 2004).

Shared Decision Making Metrics

NCQA HEDIS 2015 CAHPS Health Plan & CAHPS PCMH Survey:

  • 2014 Health Plan Q10 and PCMH Q29. Did you and a doctor or other health provider talk about the reasons you might want to take a medicine? Response: Yes, No
  • Health Plan Q11 and PCMH Q30. Did you and a doctor or other health provider talk about the reasons you might not want to take a medicine? Response: Yes, No
  • Health Plan Q11 and PCMH Q30. Did you and a doctor or other health provider talk about the reasons you might not want to take a medicine? Response: Yes, No
  • Health Plan Q12 and PCMH Q31. When you talked about starting or stopping a prescription medicine, did a doctor or other health provider ask you what you thought was best for you? Response: Yes, No

Medical Expenditures Panel Survey:

  • Patient-centeredness/Shared Decision making: “usual source of care always asks them to help makes decisions when there is a choice between treatments” (Cunningham, 2015)

Process Level Tracking:

  • Orders for decision aids in electronic health records
  • Patient satisfaction scores

Preferences sensitive condition/procedure tracking

  • Examples include knee or hip replacement surgery, low back surgery, contraception use, colon cancer screening
  • Distribution of decision aid at time of specialist referral

Costs Associated with Shared Decision Making