Research has shown that when patients are actively involved in their health care, they tend to have better outcomes. One emerging strategy that conveys this idea is shared decision-making (SDM) – the process of using medical evidence and patient values to come to a conclusion about treatment. The Minnesota Shared Decision-Making Collaborative (MSDMC), a multi-stakeholder community learning collaborative formed in 2008, is working to remove barriers to adoption and promote the routine use of SDM in clinical practice throughout Minnesota.
Stratis Health, the Quality Improvement Organization (QIO) for Minnesota, and a number of key community stakeholders, are working to develop standardized approaches to defining, performing, and measuring SDM and decision quality. The collaborative is continuing to progress toward its goals with the launch of an expanded website.
Building a Foundation
The MSDMC started as a coalition and evolved into a steering committee with work groups focused on different topics, such as patient engagement, online resources, media and provider education. “From the beginning, we were able to capitalize on the passion and engagement of the participants in each work group,” said Vick Olson, Program Manager. “It really set the stage for collaboration. But as the work of the specific committees changed, the structure has also changed.”
The steering committee now focuses on networking and updating MSDMC participants on projects in the community, and specific work related to website development. Initially, the original patient engagement work group was charged with providing messages to the community. They held six focus groups in order to establish key messages that built the basis for a consumer campaign.
“We discovered that people didn’t know what shared decision-making was, so we had to take a step back and look at implementation at the provider level,” Olson said. “This initiated therevision of the website, which included adding a roadmap with tools for implementation.”
The patient engagement work group has evolved into an online resource center team to further support organizations in implementing SDM.
The MSDMC’s expanded website is designed to serve as a resource for those interested in enhancing effective SDM between patients and their health care teams. It offers a variety of tools and resources, including a downloadable roadmap that serves as a toolkit to help health care organizations research, develop and implement a SDM approach at their facility.
“Our vision for the roadmap was to help facilitate SDM for all providers in the community,” Olson said. The MSDMC approached the roadmap in the way that an organization would go about implementing SDM. It takes users through the step-by-step process: Create, Choose, Assess, Define, Design, Measure, Sustain.
“The roadmap includes concrete items in organizational tools and measurements,” Olson said. “But because people sometimes focus too much on tools like decision aids instead of incorporating values and preferences into their decision-making, we tried to broaden the conversation and look more at the overall process of SDM.”
The MSDMC believes that one of its success factors is having a diverse group of community leaders with a variety of skill sets and resources. “We’re a really creative, dedicated group,” Olson said. We were able to analyze the focus group feedback to identify the gaps in understanding SDM. That analysis helped us fine-tune our website revision and develop the roadmap and supporting resources to address those gaps.”
Stratis Health’s previous experience developing websites and resources and partnering with other health care organizations was also valuable to the partnership. “We were able to bring the various groups together into one room and match up parts of the project with appropriate skill sets,” Olson said.
The MSDMC continues to raise awareness of SDM and encourage pilots of clinical implementation in Minnesota. To help providers understand what is involved with SDM, the collaborative is working on provider competency and educational tools. In addition, there are plans to add resources and tools for patients to educate them on their role in SDM. “The importance of SDM is about moving the conversation with the patient to a deeper level of understanding. It’s all about the patient’s values and preferences, and it frames the patient-provider conversation in a completely new light,” Olson said.