Patient Decision Quality Initiative

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Patient Decision Quality Initiative

• University of North Carolina at Chapel Hill
• Carmen Lewis, MD, MPH
• Alison Brenner, MPH
• Michael Pignone MD MPH

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Center for Decision Quality

• Location, Chapel Hill, NC
• Sheps Center for Health Services Research,
  University of North Carolina at Chapel Hill
• General Internal Medicine practice, Ambulatory
  Care Center, UNC Health Care

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Center for Decision Quality

• People
• Carmen Lewis, MD, MPH Principal Investigator
• Michael Pignone, MD, MPH Co-Investigator
• Robb Malone, PharmD Co-Investigator
• Alison Brenner, MPH Project Manager
• Shaun McDonald, BS Programmer
• Christopher DeLeon, MA Project Assistant

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Center for Decision Quality

• Patient Population
• Academic General Internal Medicine Practice
• Resident and Attending Physicians

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Distribution Models Implemented

• Mailings
• Unassociated with upcoming visit
• In clinic
• Use decision aids in practice
• Care Assistant delivery
• Pre-visit plus
• Mailed decision aids associated with upcoming
  visit
• Care Assistant follow up in clinic during
  appointment

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Greatest Disappointment

• Mailings
• CRC screening test completion
• Difference 11 (CI 318)
• DA viewing
• 137 packages sent
• 71 (52) no response with mailing alone
• 17/ 88 (19) watched video per mailings and calls

Lewis Implement Sci. 2008 Jun 2332.
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Greatest Success

• Pre-visit Plus Model
• 51 (68 of 134) who attended their visit viewed
  at least some of the PSA DA
• 94 (64 of 68) viewed the whole DA
• 51 perfect knowledge score

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Next Steps

• Delivery
• Multiple models necessary
• Tailor to DA and type of patient
• Engage Clinic Staff to be sustainable
• Obtain buy-in from patients, staff, and
  physicians
• CQI techniques to assist us
• Patient identification
• Time consuming
• Automate for multiple DAs

Lewis N C Med J. 2009 Mar-Apr70(2)136-9.
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