Diabetes Interventions: Creating Patient-Centered Conversations

1. Jeff Sloan, PhD Timothy Beebe, PhD David Eton, PhD Annie LeBlanc, PhD Jennifer Ridgeway, MPP Kari Ruud, MEd Kathleen Yost, PhD Jeanette Y. Ziegenfuss, PhD Victor Montori, MD, MSc Diabetes Interventions: Creating Patient-Centered Conversations Adaption of eDecision Aids Prototype: Incorporating the Patient Voice via PROs Shared Decision Making Intervention Project Overview PRO Intervention Project Overview Background Development of Hypertension DA Objective Task #1:Complete formative research: review alternative measurement tools, select core generic and disease-specific tool set, conduct cognitive interviews, finalize tools. Task #2:Develop user interface: review existing structures, devise output formats iteratively, mock output run. Task #3:Develop patient and provider report formats: review existing formats, add/modify report formats. Task #4:Clinical integration feasibility testing: Beta-test of PRO reporting system. Task #5:Design analytic framework (create analysis plans): produce clinical pathway algorithms, dynamic real-time triggers. Task #6:Benchmarking of BEACON population well-being estimates: produce summary system reports of population estimates for BEACON sites. Background/Need: Diabetes prevalence has been rising in the past few decades due to increasing obesity and population aging. The aim of this project is to have a meaningful impact on care of the diabetic population byincorporating the patient voice as a major driver towards realistic care plans that account for a patient’s reality. • Objective • Provide the means by which patients with type 2 diabetes can tailor their medicines to reduce their risk of heart disease to their context, improving adherence to therapy and cardiovascular risk reduction. • Specific Aims • Aim #1: Develop and adapt tailored decision aids for diabetes to the EHR environment (eDecision Aids). • Task #1: Develop hypertension decision aid • Task #2: Adapt Wiser Choices decision aids to the EHR • Task #3: Implement measures of interest • Aim #2: Assess the impact of implementation of eDecision Aids on diabetes performance measures and patient important outcomes in a multi-center randomized control trial. • Use of eDAs during the clinical encounter vs. usual care • Measure of outcomes at post encounter and at 3, 6, 12 months “What is your single biggest concern right now?” Integrate patient-reported outcomes (PROs) consistently and efficiently into the BEACON network with minimum burden to the patient, clinicians, and affiliated systems to improve clinical outcomes including patient well-being, quality of life and treatment outcomes in primary and secondary care. Chronic conditions account for > 60% of Medicare costs. One in three Americans is at risk of developing diabetes. DA Background Wiser Choices Program: Our Work Thus Far 13 decision aids Chronic and acute care Primary care, subspecialty, and ER In/out patient settings Rural and urban communities > 50 sites > 200 clinicians > 600 patients PROs as Integrated Vital Signs Real-Time Quality of Life (QOL) Decision Aids (DA) Measures of Interest Systematic review of 55 RCTs of 30 decision aids (DA) Increased patient involvement: RR 1.7 (95% CI 1.3, 2.0) Improved patient knowledge: 15% (95% CI 12, 19) Reduced decisional conflictby 9.3/100 (95% CI 6, 13) Reduced proportion undecided: RR 0.5 (95% 0.3, 0.8) No difference in satisfaction, health outcomes • Metabolic parameters (HbA1c, cholesterol, BP) • Hard outcomes (e.g., MI) and utilization (e.g., ED visits) • Medication use (aspirin, statins, antiBP, antiglu) • Self report (medication reconciliation, prescribed) • Adherence • Patient reported outcomes • Quality of life and functional capacity • Burden of treatment • Decision making quality • Knowledge transfer (topic dependent) • Quality of deliberation (OPTION, COMRADE, DELIBERATE) • Satisfaction (generic, but less meaningful) Exchange Deliberate Consensus PRO = Patient-reported outcome QOL = Quality of life  2011 Mayo Foundation for Medical Education and Research