Developing and Evaluating a Clinic-Based Decision Aid Delivery System
Background: Despite evidence of their benefits, decision aids (DAs) have not been widely adopted in clinical practice. Quality improvement methods could help embed DA delivery into primary care workflows and facilitate DA delivery and uptake, defined as reading or watching DA materials. Objectives:...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2016-07-01
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| Series: | MDM Policy & Practice |
| Online Access: | https://doi.org/10.1177/2381468316656850 |
| _version_ | 1819066785426571264 |
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| author | Carmen L. Lewis MD, MPH Alexandra F. Dalton PhD Lauren Drake BS Alison T. Brenner PhD Cristin M. Colford PhD Chris DeLeon MA Shaun McDonald BS Carolyn B. Morris MPH Matthew Waters MD Lisa Werner MA Ed Arlene Chung MD, MHA, MMCi |
| author_facet | Carmen L. Lewis MD, MPH Alexandra F. Dalton PhD Lauren Drake BS Alison T. Brenner PhD Cristin M. Colford PhD Chris DeLeon MA Shaun McDonald BS Carolyn B. Morris MPH Matthew Waters MD Lisa Werner MA Ed Arlene Chung MD, MHA, MMCi |
| author_sort | Carmen L. Lewis MD, MPH |
| collection | DOAJ |
| description | Background: Despite evidence of their benefits, decision aids (DAs) have not been widely adopted in clinical practice. Quality improvement methods could help embed DA delivery into primary care workflows and facilitate DA delivery and uptake, defined as reading or watching DA materials. Objectives: 1) Work with clinic staff and providers to develop and test multiple processes for DA delivery; 2) implement a systems approach to measuring delivery and uptake; 3) compare uptake and patient satisfaction across delivery models. Methods: We employed a microsystems approach to implement three DA delivery models into primary care processes and workflows: within existing disease management programs, by physician request, and by mail. We developed a database and tracking tools linked to our electronic health record and designed clinic-based processes to measure uptake and satisfaction. Results: A total of 1144 DAs were delivered. Depending on delivery method, 51% to 73% of patients returned to the clinic within 6 months. Nurses asked 67% to 75% of this group follow-up questions, and 65% to 79% recalled receiving the DA. Among them, uptake was 23% to 27%. Satisfaction among patients who recalled receiving the DA was high. Eighty-two to 93% of patients reported that they liked receiving this patient education information, and 82% to 91% reported that receiving patient education information like this is useful to them. Conclusion: Our results demonstrate the realities of clinical practice. One fourth to one third of patients did not return for a follow-up visit. Although nurses were able to assess uptake in the course of their usual duties, the results did not achieve the standards typically expected of clinical research. Despite these limitations, uptake, though modest, was similar across delivery methods, suggesting that there are multiple strategies for implementing DAs in clinical practice. |
| first_indexed | 2024-12-21T16:07:53Z |
| format | Article |
| id | doaj.art-90a17f0e81494629ab1da14e39079219 |
| institution | Directory Open Access Journal |
| issn | 2381-4683 |
| language | English |
| last_indexed | 2024-12-21T16:07:53Z |
| publishDate | 2016-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | MDM Policy & Practice |
| spelling | doaj.art-90a17f0e81494629ab1da14e390792192022-12-21T18:57:51ZengSAGE PublishingMDM Policy & Practice2381-46832016-07-01110.1177/2381468316656850Developing and Evaluating a Clinic-Based Decision Aid Delivery SystemCarmen L. Lewis MD, MPHAlexandra F. Dalton PhDLauren Drake BSAlison T. Brenner PhDCristin M. Colford PhDChris DeLeon MAShaun McDonald BSCarolyn B. Morris MPHMatthew Waters MDLisa Werner MA EdArlene Chung MD, MHA, MMCiBackground: Despite evidence of their benefits, decision aids (DAs) have not been widely adopted in clinical practice. Quality improvement methods could help embed DA delivery into primary care workflows and facilitate DA delivery and uptake, defined as reading or watching DA materials. Objectives: 1) Work with clinic staff and providers to develop and test multiple processes for DA delivery; 2) implement a systems approach to measuring delivery and uptake; 3) compare uptake and patient satisfaction across delivery models. Methods: We employed a microsystems approach to implement three DA delivery models into primary care processes and workflows: within existing disease management programs, by physician request, and by mail. We developed a database and tracking tools linked to our electronic health record and designed clinic-based processes to measure uptake and satisfaction. Results: A total of 1144 DAs were delivered. Depending on delivery method, 51% to 73% of patients returned to the clinic within 6 months. Nurses asked 67% to 75% of this group follow-up questions, and 65% to 79% recalled receiving the DA. Among them, uptake was 23% to 27%. Satisfaction among patients who recalled receiving the DA was high. Eighty-two to 93% of patients reported that they liked receiving this patient education information, and 82% to 91% reported that receiving patient education information like this is useful to them. Conclusion: Our results demonstrate the realities of clinical practice. One fourth to one third of patients did not return for a follow-up visit. Although nurses were able to assess uptake in the course of their usual duties, the results did not achieve the standards typically expected of clinical research. Despite these limitations, uptake, though modest, was similar across delivery methods, suggesting that there are multiple strategies for implementing DAs in clinical practice.https://doi.org/10.1177/2381468316656850 |
| spellingShingle | Carmen L. Lewis MD, MPH Alexandra F. Dalton PhD Lauren Drake BS Alison T. Brenner PhD Cristin M. Colford PhD Chris DeLeon MA Shaun McDonald BS Carolyn B. Morris MPH Matthew Waters MD Lisa Werner MA Ed Arlene Chung MD, MHA, MMCi Developing and Evaluating a Clinic-Based Decision Aid Delivery System MDM Policy & Practice |
| title | Developing and Evaluating a Clinic-Based Decision Aid Delivery System |
| title_full | Developing and Evaluating a Clinic-Based Decision Aid Delivery System |
| title_fullStr | Developing and Evaluating a Clinic-Based Decision Aid Delivery System |
| title_full_unstemmed | Developing and Evaluating a Clinic-Based Decision Aid Delivery System |
| title_short | Developing and Evaluating a Clinic-Based Decision Aid Delivery System |
| title_sort | developing and evaluating a clinic based decision aid delivery system |
| url | https://doi.org/10.1177/2381468316656850 |
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