Healthc (Amst) - Incentivizing shared decision making in the USA--where are we now?

Tópicos

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Resumo

CKGROUND: The Affordable Care Act raised significant interest in the process of shared decision making, the role of patient decision aids, and incentivizing their utilization. However, it has not been clear how best to put incentives into practice, and how the implementation of shared decision making and the use of patient decision aids would be measured. Our goal was to review developments and proposals put forward.METHODS: We performed a qualitative document analysis following a pragmatic search of Medline, Google, Google Scholar, Business Source Complete (Ebscohost), and LexisNexis from 2009-2013 using the following key words: "Patient Protection and Affordable Care Act", "Decision Making", "Affordable Care Act", "Shared Decision Making", "measurement", "incentives", and "payment."RESULTS: We observed a lack of clarity about how to measure shared decision making, about how best to reward the use of patient decisions aids, and therefore how best to incentivize the process. Many documents clearly imply that providing and disseminating patient decision aids might be equivalent to shared decision making. However, there is little evidence that these tools, when used by patients in advance of clinical encounters, lead to significant change in patient-provider communication. The assessment of shared decision making for performance management remains challenging.CONCLUSION: Efforts to incentivize shared decision making are at risk of being limited to the promotion of patient decision aids, passing over the opportunity to influence the communication processes between patients and providers.

Resumo Limpo

ckground afford care act rais signific interest process share decis make role patient decis aid incentiv util howev clear best put incent practic implement share decis make use patient decis aid measur goal review develop propos put forwardmethod perform qualit document analysi follow pragmat search medlin googl googl scholar busi sourc complet ebscohost lexisnexi use follow key word patient protect afford care act decis make afford care act share decis make measur incent paymentresult observ lack clariti measur share decis make best reward use patient decis aid therefor best incentiv process mani document clear impli provid dissemin patient decis aid might equival share decis make howev littl evid tool use patient advanc clinic encount lead signific chang patientprovid communic assess share decis make perform manag remain challengingconclus effort incentiv share decis make risk limit promot patient decis aid pass opportun influenc communic process patient provid

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