Current Projects

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

DECISION QUALITY

Matching the Right Patient to the Right Treatment: Shared Decision Making for High-Cost Elective Procedures

Years: 2018 –2020

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 Partners HealthCare and beyond.

Funding provided by Donaghue Foundation-Greater Value Portfolio

Does “Perfected Informed Consent” Improve Trust in the Physician and Reduce Regret Following Orthopedic Surgery?”

Years: 2018 –2020

This research project was funded by CRICO, which is the insurance program that insures all of the Harvard medical institutions and their affiliates. At Partners HealthCare, many patients receive patient decision aids prior to hip and knee arthroplasty and surgery for herniated disc and spinal stenosis, but many do not. This situation creates a “natural experiment” we will use to study whether prescription of a patient decision aid prior to these operations increases trust in the clinician and reduces regret about the decision, which should result in lower malpractice risk.

Funding provided by CRICO

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)

Participation in a Trial Evaluating the Alignment of Treatment Preferences and Repair Type for Veterans with Abdominal Aortic Aneurysm (AAA)

Years: 2017-2022

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)

ACP Peace: Promoting Effective & Aligned Communication in the Elderly

Years:  2018- 2023

The goal of this project is to improve the quality of medical care delivered to older Americans with cancer through complementary interventions: clinical communication skills training (VitalTalk Training) and patient video decision aids (ACP videos). This is a randomized trial being conducted in three large health care systems with 4500 patients over age 65 with advanced cancer.

Funding provided by National Institutes of Health (NIH)

 

DECISION AIDS

Comparative Effectiveness of Decision Aids for Hip and Knee Osteoarthritis

Years: 2016-2018

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 orthopedic surgeon for hip or knee osteoarthritis were 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 the 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)

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

Years:  2017-2018

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

Years:  2018-2019

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

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

 

MEASURES

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)

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)

Validation of the Behavior Change Outcome Questionnaire

Years: 2017 –2020

The goal of this study is to determine whether primary care physicians’ rating of patients’ self-management effectiveness for type 2 diabetes correlates with patients’ reports of self-management effectiveness on a three-item Behavior Change Outcome Questionnaire.  This is a validation study taking place at Massachusetts General Hospital.

Funding provided by Healthwise