Article Text
Abstract
Background Shared decision-making (SDM) has become a policy priority, yet its implementation is not routinely assessed. To address this gap we tested the delivery of CollaboRATE, a 3-item patient reported experience measure of SDM, via multiple survey modes.
Objective To assess CollaboRATE response rates and respondent characteristics across different modes of administration, impact of mode and patient characteristics on SDM performance and cost of administration per response in a real-world primary care practice.
Design Observational study design, with repeated assessment of SDM performance using CollaboRATE in a primary care clinic over 15 months of data collection. Different modes of administration were introduced sequentially including paper, patient portal, interactive voice response (IVR) call, text message and tablet computer.
Participants Consecutive patients ≥18 years, or parents/guardians of patients <18 years, visiting participating primary care clinicians.
Main measures CollaboRATE assesses three core SDM tasks: (1) explanation about health issues, (2) elicitation of patient preferences and (3) integration of patient preferences into decisions. Responses to each item range from 0 (no effort was made) to 9 (every effort was made). CollaboRATE scores are calculated as the proportion of participants who report a score of nine on each of the three CollaboRATE questions.
Key results Scores were sensitive to mode effects: the paper mode had the highest average score (81%) and IVR had the lowest (61%). However, relative clinician performance rankings were stable across the different data collection modes used. Tablet computers administered by research staff had the highest response rate (41%), although this approach was costly. Clinic staff giving paper surveys to patients as they left the clinic had the lowest response rate (12%).
Conclusions CollaboRATE can be introduced using multiple modes of survey delivery while producing consistent clinician rankings. This may allow routine assessment and benchmarking of clinician and clinic SDM performance.
- PRIMARY CARE
- shared decision-making
- patient-reported experience measure
- patient-reported measurement
- mode effects
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
▸ Additional material is available. To view please visit the journal online (http://dx.doi.org/10.1136/bmjopen-2016-014681).
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Contributors PJB contributed to design of the work, drafting the article and final approval of the version to be published. RCF contributed to design of the work, data analysis and interpretation, drafting the article and final approval of the version to be published. RT contributed to design of the work, critical revision of the article and final approval of the version to be published. EMO contributed to design of the work, data collection, data analysis and interpretation, critical revision of the article and final approval of the version to be published. RA contributed to the design of the work and final approval of the version to be published. MGC contributed to design of the work, data collection, critical revision of the article and final approval of the version to be published. AJO contributed to design of the work, data interpretation, critical revision of the article and final approval of the version to be published. GE contributed to conception and design of the work, drafting the article and final approval of the version to be published.
Funding This work was funded by the Gordon and Betty Moore Foundation, grant number 3929.
Competing interests GE reports personal fees from Emmi Solutions LLC, personal fees from National Quality Forum, personal fees from Washington State Health Department, personal fees from Shared Decision Making 3rd edition, personal fees from Groups (Radcliffe Press), outside the submitted work; and GE has initiated and led the Option Grid patient decision aids Collaborative, which produces and publishes patient knowledge tools in the form of comparison tables (http://optiongrid.org/). GE has been a member of teams that have developed measures of shared decision-making and care integration. These tools and measures are published and are available for use. For further information see http://www.glynelwyn.com/.
Ethics approval The study received ethics approval by Dartmouth Committee for the Protection of Human Subjects (#24529).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.