Past projects from HDSC faculty and staff in the following areas:
Engaging patients in decisions about rescheduling colonoscopies delayed due to COVID-19
Years: 2020 – 2021
Given the COVID-19 pandemic, one pressing issue facing health care systems was how to manage the large and growing backlog of screening tests and elective procedures. Managing demand with reduced capacity represents a key new challenge for health care delivery systems during this crisis. Many patients may feel differently about the value of seeking healthcare, including cancer screening, during the COVID-19 pandemic. In this PCORI-funded study, we examined patients’ preferences for rescheduling a screening or colonoscopy that was delayed or postponed due to COVID. Then, we studied whether shared decision making tools and training increased patients involvement in decisions, increased their intention to follow through with some type of colon cancer screening, and reduced decisional conflict. There were many challenges to resuming healthcare during this crisis, and this study addressed important research questions about how to do this in a safe, equitable and patient-centered manner.
Funding from the Patient-Centered Outcomes Research Institute (PCORI)
The EPIC Roundtrip Project – Qualitative Assessment
The EPIC Roundtrip is the ability for providers to electronically prescribe patient decision aids in Epic, and for patients to electronically send a summary of their knowledge score, preferences and treatment leaning back to their provider. We will conduct up to 20 interviews with patients and providers to evaluate how they interact with the Roundtrip process.
Funding from Healthwise
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 from the Donaghue Foundation-Greater Value Portfolio
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 from Healthwise
Effect of decision aids on decision making for the treatment of common urogynecology conditions
The aim of this project is to determine the feasibility and efficacy of decision aids (DAs) in the field of Urogynecology. More specifically, the goal of this project is to determine if DA’s can increase patient knowledge regarding their diagnosed condition, increase patient confidence in their treatment decisions, and fit into the workflow of a Urogynecology clinic.
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 planned 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 also randomized 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 from Patient-Centered Outcomes Research Institute (PCORI)
Use of Electronic Messaging to Integrate Screening and Online Coaching for Unhealthy Alcohol Use
This research project, which was conducted at the University of North Carolina-Chapel Hill, evaluated the effect of decision support material on unhealthy alcohol use. The decision support program was delivered electronically via a secure Epic patient portal, and the patient’s response to the decision support program was returned electronically to the patient’s medical record.
Funding provided by Healthwise
Managing Expectations for Acute Low Back Pain Study (MAPS)
Making decisions about treatment of acute low back pain (ALBP) can be challenging for both clinicians and patients. In 2013, the HDSC and the MGH back pain care redesign team received a Clinical Innovation Award to examine shared decision making in the management of acute low back pain (ALBP) with three urgent care clinics. Practice guidelines were developed to support physicians in the treatment of back pain; however, patients also need to be informed about what ALBP is and what treatment options are available. This project evaluated the integration of an acute low back pain patient decision aid in urgent care settings at MGH.
Funding provided by MGH Clinical Innovation Award
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 obstetric outcome, and to test if the 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
Does “Perfected Informed Consent” Improve Trust in the Physician and Reduce Regret Following Orthopedic Surgery?”
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 surgeon and reduces regret about the decision, which should result in lower malpractice risk.
Funding from the CRICO
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 from the National Heart, Lung, and Blood Institute (NHLBI)
What Engagement Looks Like (WELL) Scale
Years: 2018 – 2019
The goal of the study was 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 was a validation study taking place at Massachusetts General Hospital.
Funding from Healthwise
Making Orthopedic Referrals Enhanced with Technology and Education study (MORE)
The decision to have treatment for hip and knee osteoarthritis, spinal stenosis, or herniated disc is dependent on many factors. In 2013, the HDSC was awarded a grant from the Gordon and Betty Moore Foundation to understand how patients make treatment decisions for these four conditions. Through this grant, we were able to successfully determine how we can reliably integrate decisions into routine orthopedic care to promote shared decision making. This study evaluated the impact of the care redesign initiatives by examining the quality of the decision-making process for patients considering surgical and non-surgical treatment options.
Funding provided by The Gordon and Betty Moore Foundation
Resident Skills Training
With funding from the Picker Institute and the Arnold P. Gold Foundation, the SDM team developed and delivered a workshop, during a regularly scheduled ambulatory curriculum rotation, to introduce internal medicine residents to shared decision making concepts, give them practice in shared decision making skills, and demonstrate the use of a simple tool to facilitate shared decision making in common clinical encounters. One hundred thirty internal medicine and medicine-pediatrics residents attended 8 workshops over a 4-month period. The training workshop for internal medicine residents was rated highly by attendees and the majority stated they would change their practice based on what they learned.
Funding provided by The Gold Foundation
Depression and Diabetes Mental Health Initiative
The Alice Rosenwald Mental Health Integration Initiative funded the Mental Health Initiative (MHI) project from January 2015 – December 2016. This project was based in the Internal Medicine Associates (IMA), an adult primary care practice located within the main campus of MGH. The goal of the MHI project was to build on an existing Depression Care (“D-Care”) Initiative at MGH to enhance screening for depression in patients and to improve collaborative management of depression care between primary care teams and behavioral health experts. The MHI program focused on diabetic patients, as studies have shown this population has high rates of depression. The MHI team provided training to medical staff at all levels (including medical assistants and registered nurses). These sessions covered skills such as health coaching, motivational interviewing, shared decision making, and training in behavioral activation for depression care.
Funding provided by Alice Rosenwald Mental Health Integration Initiative