11:40 am - 12:00 pmSunday, September 18
LK 102
Use of a patient-facing interactive software platform to improve the quality of medical decisions in clinic
LK 102
Use of a patient-facing interactive software platform to improve the quality of medical decisions in clinic
Improving patient engagement in evidence-based decision making is a key tactic that has improved value in a variety of clinical settings. We evaluated patient ‘decisional quality’ in several common... Read more

Description

Improving patient engagement in evidence-based decision making is a key tactic that has improved value in a variety of clinical settings. We evaluated patient ‘decisional quality’ in several common and expensive decision settings at our health system (treatment for benign prostatic hyperplasia, prostate cancer, low back pain, women’s choice of birth control, and newborn delivery method). We found that while satisfaction was high, both decisional conflict and condition-specific knowledge after physician counseling were below expectations. Pre-implementation surveys found patients have significant knowledge gaps after physician counseling (e.g., most pregnant women erroneously believe that a Cesarean section is required for babies >9.5 lbs.; few women are familiar with birth control options such as the contraceptive sponge and tubal ligation; many patients with herniated discs are unaware that pain will improve without surgery and are overly optimistic about the expected level of pain 1 year after surgery). Many patients also had significant decisional conflict after treatment selection with their physician, which is associated with delays in care and greater chance of blaming physicians for bad outcomes. We also found evidence of inappropriate use, especially in regards to the use of caesarean section for routine childbirth. The decisions we evaluated were “preference sensitive,” meaning patient values play a key role in identifying the optimal treatment choice.

We implemented an interactive software application (“WiserCare”) prior to the physician consult. The software ingests patient clinical data relevant to a decision, interviews patients to determine the relative strength of their values for the decision, and performs an instantaneous decision analysis. The platform is used prior to the physician visit, and generates an educational report for patient use in preparation for the clinic visit and a summary version for physician review. The software generates a personalized report of the patient’s preferences as well as which evidence-based treatments may best match the patient’s clinical and personal situation. The summary report is emailed to the physician prior to an outpatient clinic visit, in order to center the discussion on patient values and improve the efficiency of the visit.

We analyzed clinic workflows to determine how best to integrate the program without disrupting care. We educated physicians about the current state and why they could benefit from participation in the program. We first implemented the prostate cancer module, and saw significant improvements in decisional quality. Patients to date (N=125) that underwent the software intervention demonstrated higher satisfaction with care (98.4%), higher satisfaction with decision making (99.2%), and increased disease-specific knowledge (81.6%), compared to baseline measurement of these variables after the physician visit.. 30% of patients chose to provide qualitative written feedback about the application. 86% of these comments were uniformly positive, with most feedback indicating the tool was “helpful” “informative” and that the “overall process was good”

We are now scaling up the program by implementing the other conditions. Early qualitative analysis also shows that these patients continue to indicate that the tool is “helpful”. We are learning that implementation needs to be responsive to clinic contexts. We are collecting data on impact on decisional conflict, disease specific knowledge, satisfaction, and utilization patterns.

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