Current Projects

Here are some of the projects currently underway at the Health Decision Sciences Center and the Informed Medical Decisions Program:

Comparative effectiveness of Decision Aids for hip and knee osteoarthritis

Our PCORI funded study titled “Comparative Effectiveness of Decision Support Tools for Total Joint Replacement” is a three-year grant. We plan to enroll more than 1100 patients in this multi-site trial. Patients coming to see a participating orthopaedic surgeon for hip or knee osteoarthritis are randomly assigned to receive one of two different decision aids. We are also randomizing surgeons to receive a short report about their patients’ goals and treatment preferences or not. We hope to learn more about how decision aid format can influence decision-making and health outcomes. Furthermore, we are eager to explore if formally delivering patient preferences to surgeons helps improve the accuracy of preference diagnosis.

Funding provided by: Patient-Centered Outcomes Research Institute (PCORI)

Consumer Assessment of Healthcare Providers and Systems (CAHPS V)

The CAHPS surveys are the most widely used patient experience surveys. The main goal of the grant is to develop and evaluate the next generation of CAHPS surveys. Dr. Sepucha and others in the HDSC are working to examine ways to incorporate shared decision making and measurement of decision quality into the CAHPS assessments.

Funding provided by: Agency for Healthcare Research and Quality (AHRQ)

Enabling a paradigm shift: a preference-tolerant RCT of personalized vs. annual breast cancer screening

This is a large randomized trial comparing the effectiveness of annual mammography with personalized screening for breast cancer. The overall study is being run by Dr. Laura Esserman at University of California San Francisco, and Dr. Sepucha is co-leading the patient reported outcomes group to understand patients’ decision making about trial participation, adherence to screening recommendations, and the role of genetic testing on anxiety and regret among participants.

Funding provided by: Patient-Centered Outcomes Research Institute (PCORI)

Measuring Decision Quality for patients with coronary artery disease

The purpose of the study, led by Drs. Dudley and Lin at the University of California San Francisco, is to develop and evaluate a new survey instrument to measure decision quality for coronary revascularization decisions.

Funding provided by: National Heart, Lung, and Blood Institute (NHLBI)

Patient-directed Decision Aid ordering projects

Several practices have been utilizing a workflow that provides patients with the opportunity to self-order two decision aid programs of interest. An order sheet was developed with a short description of top decision aids.  This order sheet is given to all patients arriving for their annual visit. The front desk staff will give the patient the order sheet to review. The medical assistant will collect the order form during work-up and place the decision aid order in the electronic medical record. Patients have been very interested in ordering programs both for themselves or a family member. We have seen an increase in decision aid orders over the last few years.

Funding provided by: Massachusetts General Physicians’ Organization and Partners Center for Population Health

Matching the right patient to the right treatment: shared decision making for high cost elective procedures

This is a three-year grant that will examine whether routine measurement of shared decision making (SDM) for elective surgery decisions, with feedback to clinicians and administrators, has the potential to improve the value of care provided to patients. We plan to enroll 1200 patients in this multi-site trial. Patients who have undergone surgery for hip or knee osteoarthritis, spinal stenosis, or herniated disc will be surveyed to assess the rate of informed, patient centered decisions. The study will examine how the quality of decisions impact value including patient experience, health outcomes, and costs across the system. We will explore how the data and measures may be used to design incentives to promote SDM and increase value across the Partners HealthCare network and beyond.

Funding provided by: Donaghue Foundation-Greater Value Portfolio

Use of Electronic Messaging to Integrate Screening and Online Coaching for Unhealthy Alcohol Use

This research project, which is being conducted at the University of North Carolina-Chapel Hill, will evaluate the effect of decision support material on unhealthy alcohol use. The decision support program will be delivered electronically via a secure Epic patient portal, and the patient’s response to the decision support program will be returned electronically to the patient’s medical record.

Funding provided by: Healthwise

Implementation and evaluation of a certified patient decision aid for women considering birth options after a prior cesarean

This is a pilot research project being conducted at the University of North Carolina Obstetrics practices to evaluate the implementation, utilization and acceptability of a certified patient decision aid on birth options after a prior cesarean. Data will be collected on knowledge, decision process, patient preferences, patient satisfaction and clinical processes.

Funding provided by: Healthwise

Evaluation of a patient decision aid on liability protection

We conducted a series of focus groups to evaluate the decisions of potential jurors in scenarios where a patient had an adverse obstetrics outcome, and to test if use of a decision aid, when choosing between a trial of labor or a repeat cesarean after a prior cesarean, reduces medical liability exposure.

Funding provided by: Healthwise

Development of measures of how conditions affect patients’ lives and how well patients are managing their chronic conditions

We developed two short questionnaires designed to measure the impact of health conditions on individuals’ functioning, and to measure how engaged they are in self-managing their chronic conditions. We will conduct two studies to assess their validity and reliability.

Funding provided by: Healthwise

Participation in a trial evaluating the alignment of treatment preferences and repair type for Veterans with abdominal aortic aneurysm (AAA)

Collaboration on a trial being conducted in a network of VA Medical Centers to assess patient and surgeon preferences for AAA repair and whether a decision aid helps match treatment to patient preferences. Shared decision making skills training will be offered to participating surgeons.

Funding provided by: Veterans Affairs (VA)