Health Dialog Connections

Understanding the Full Story on Shared Decision Making

There was a buzz created last week with the release of a recent study that appeared online in JAMA Internal Medicine on May 27, 2013. While the paper itself presented the results cautiously, the accompanying news release entitled “When doctors and patients share in decisions, hospital costs go up,” provided a skewed representation of Shared Decision Making (SDM) and the associated benefits of improving the quality of care and reducing costs.

And, appropriately, there is now an evidence-based rebuttal to provide a broader perspective on the story. The Informed Medical Decisions Foundation posted a strong counter-argument on their blog that highlights several shortcomings and assumptions in the survey’s methods and findings. 

At Health Dialog, we believe that Shared Decision Making is the right thing to do for patients and can impact costs by assuring that patients get the care they want -- nothing  more, nothing less.  Shared Decision Making adoption is growing rapidly nationwide as studies enhance the support for the practice and multiple academic and peer-reviewed studies can attest to the value of SDM.

For example, a recent study I authored with my colleagues that was published in Health Affairsfocuses on patients with preference-sensitive conditions. The study was conducted to gain understanding on how different levels of support (including Shared Decision Making support) affected  individuals who face preference-sensitive decisions. Veroff and his co-authors looked at 60,185 individuals who were identified as potential candidates for Shared Decision Making for one of six preference-sensitive conditions: Heart risk, benign uterine condition risk, benign prostate hyperplasia risk, back risk, hip risk, and knee risk. After a year-long randomized study, the intervention group (which had broad levels of support) had $23 lower costs pepm, 12.5% fewer hospital admissions, and 9.9% fewer preference sensitive surgeries than a lower level of support control group. The study results were strong, showing that providing Shared Decision Making support to individuals with preference sensitive conditions reduced overall health costs and hospital admission costs and utilization in powerful ways.

Our mission is to empower people throughout their lives to make the health and healthcare decisions that are right for them and Shared Decision Making is a valuable and important part of this process.

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