Highlights
- •Shared decision-making implicates patients and providers making decisions together.
- •The practice of SDM remains suboptimal in many medical specialties.
- •Poor SDM was associated with worse patient-reported health outcomes.
- •Poor SDM was associated with worse established quality indicators.
- •More research is needed to understand the impact of SDM on health cost reduction.
Abstract
Background
Shared decision-making (SDM) is a process that respects the rights of patients to
be fully involved in decisions about their care. By evaluating all available healthcare
options and weighing patients' personal values and preferences against available unbiased
evidence, patients and healthcare professionals can make health-related decisions
together, as partners. We sought to evaluate the impact of perceived SDM on patient-reported
outcomes, healthcare quality, and healthcare utilization.
Methods
Patients were identified from the 2010–2014 Medical Expenditure Panel Survey (MEPS)
cohort. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey
was levied to create a weighted composite score of satisfaction with SDM on a 12-point
scale, and then categorized as optimal, average or poor SDM based on weighted scores.
Weighting and variance techniques were applied to assure results were representative
of the U.S. civilian population. Chi-square analysis was used to estimate differences
across SDM groupings and multivariate logistic regression was performed to generate
odds ratios (OR) and confidence intervals (CI).
Results
The study cohort included 63,931 responses to the survey tool. Results of SDM satisfaction
across the three categories were skewed, with 46.6% (n = 29,807) of the respondents
reporting optimal SDM, 42.1% (n = 26,887) reporting average scores and only 11.3%
(n = 7237) reporting poor perceived SDM. Non-white race, lower educational level,
low socioeconomic status, non-married status, and uninsured or underinsured status
were all associated with higher incidence of poor perceived SDM (p < .05). Poor SDM
was associated with increased odds of poor physical health scores (OR: 1.17; 95% CI
1.01–1.36) and poor mental health scores (OR: 1.53; 95% CI 1.25–1.86). Poor SDM was
associated with lower use of statins (OR: 0.77; 95% CI 0.68–0.87) and aspirin (OR:
0.86; 95% CI 0.77–0.95), both of which are established quality of care metrics. Poor
SDM was also associated with increased emergency department (ED) utilization, with
an increased likelihood of 2 or more ED visits associated with poor SDM (OR: 1.25;
95% CI 1.06–1.49).
Conclusions
Poor SDM was associated with worse patient-reported health outcomes, worse established
quality indicators, and higher healthcare utilization. While increasing physician
education may help optimize SDM, differences in patient-perceived SDM were also strongly
driven by inherent patient characteristics.
Keywords
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Article Info
Publication History
Published online: January 19, 2018
Accepted:
January 14,
2018
Received in revised form:
December 31,
2017
Received:
December 7,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
