In 2006, researchers at Seattle-based Group Health Cooperative took a closer look at the number and type of major elective surgical procedures performed across their integrated delivery system. What they found surprised them.
There were large variations in surgical care from one region to another, a fact that was especially striking because the Group Health physicians being studied were salaried and had no financial incentives to perform more elective procedures, said Dr. David Arterburn, associate investigator at the Group Health Research Institute.
Patients living in Tacoma, Wash., for instance, were far more likely to have knee replacement surgery than patients in Seattle.
“We knew there were no differences in knees in Seattle, so it had to be a difference in provider practices and the way care is delivered,” he said.
Arterburn and his team thought that introducing a comprehensive shared-decisionmaking program that included the use of high-quality decision aids—print and video tools that clearly presented the risks and benefits of specific procedures and treatments—could reduce that variation.
Shared decisionmaking is gaining traction as research points to its benefits and patients demand a greater role in their care. Evidence shows it helps patients address their questions and fears and become more confident about their treatment choices. But experts say there are significant obstacles slowing adoption, including a payment model that rewards volume, and doctors' belief that engaging in shared decisionmaking with patients will take too much time.
“Organizations can only attend to so many different things at once and, unfortunately, shared decisionmaking is often lost in the crowd,” said Dr. Richard Wexler, chief clinical integration officer at Healthwise, a Boise, Idaho-based not-for-profit that produces decision aids and other content. “It's a fundamental change in the way that caregivers and patients interact.”