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A Community System for Advancing Shared Decisionmaking

All too often, treatment decisions regarding elective procedures and preference-sensitive conditions do not take into account patient preference. One community is aiming higher by creating a system to engage patients in shared decisionmaking.

Following a 2011 CHCF study of surgical rate variation in California, leaders in Humboldt County came together to examine the causes of, and to produce recommendations to, address the region's higher-than-average rates for elective coronary artery bypass graft (CABG), carotid endarterectomy, gall bladder removal, hysterectomies, knee replacements, and bariatric surgeries for the obese. Dubbed the Surgical Rate Project (SRP), the initiative found that few patients understood the benefits and harms associated with different treatment options, and few physicians understood their patients' concerns and goals for treatment.

SRP participants quickly realized that engaging patients in shared decisionmaking would address both problems. Shared decisionmaking occurs when clinicians help patients understand the available options and the evidence for each, then elicit and integrate the patients' informed preferences into the final decision.

With support from CHCF, Humboldt Del Norte Independent Practice Association, in partnership with Informed Medical Decisions Foundation (formerly the Foundation for Informed Medical Decision Making), will develop and test an innovative approach for implementing shared decisionmaking for elective procedures. The goal for this project is to develop a reliable process for identifying patients at a decision point (or trigger event) and intervene appropriately and effectively via the development of a shared decisionmaking referral center based within an integrated physician association (IPA).

An evaluation of this pilot will be conducted, and results will be made available in 2015.

For more information, read the Eureka Times-Standard news article listed under External Links.

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