NQF Publishes Playbook on Shared Decision-Making in Healthcare

The agency says that shared decision-making is an essential part of creating more patient-centered care and must be a part of quality of care standards.

By Sara Heath

March 13, 2018 - The National Quality Forum (NQF) is calling for healthcare experts and policymakers to integrate shared decision-making as a standard of care. Shared decision-making helps support better patient engagement and integrates the patient as a member of the care team, the group said.

“Even though patients have access to more healthcare information than ever before, in reality, they often may not fully understand important (basic) information about the risks and benefits of treatments and alternatives, and even if they do, they often are not given the opportunity by their clinicians to provide meaningful input into their healthcare decisions,” said Maureen Corry, senior advisor for Childbirth Connection programs at the National Partnership for Women & Families, and co-chair of the National Quality Partners (NQP) Shared Decision Making Action Team.

Shared decision-making is the practice by which providers educate patients and subsequently elicit patient viewpoints and preferences for care. This practice integrates the patient into the care team and often results in more patient satisfaction and better outcomes.

Most clinicians use decision aids to support their shared decision-making efforts, NQF explained. Decision aids are materials that review the patient health condition and offer the pros and cons of various treatment options. These tools help patients choose the best treatment path for their physical and emotional needs.

With that call to action, NQF also published the National Quality Partners Playbook™: Shared Decision Making in Healthcare.

“Advancing the standard of care in this nation demands patient engagement, and that starts with the one-on-one conversations between patients and their providers,” said Shantanu Agrawal, MD, MPhil, president and CEO of the National Quality Forum. “The NQP Playbook offers a strategic approach that healthcare organizations can use to help ensure this communication is effective.”

The playbook covers the following topics:

·         Educating patients and families about what to expect from providers in the process

·         Advancing healthcare team knowledge and training to foster high-quality shared decision making

·         Applying technology and other investments to help integrate shared decision making into the care delivery process

·         Implementing mechanisms to monitor patient, clinician, and healthcare team engagement in shared decision making

·         Establishing accountability and incentives for this engagement

The playbook also includes example scenarios for using shared decision-making, the potential pitfalls that may arise, solutions for overcoming challenges, and tools that can help support shared decision-making in healthcare.

The playbook aims to assist providers through shared decision-making, especially when the practice becomes complicated by the many mitigating factors in a healthcare encounter.

“With many quality and performance priorities, and an evolving payment and care delivery landscape, many healthcare organizations and clinicians face challenges and need simple guidance to integrate SDM into busy clinical workflows,” NQF wrote in a summary of the playbook. “In some cases, high-quality, unbiased, evidence-based patient decision aids may add value to the SDM process.”

The guide also outlines the six foundational principles of shared decision-making in healthcare. These principles will help guide providers through the process of shared decision-making and should support the role that patients play in their own health:

·         Leadership and culture in healthcare organizations

·         Enhance patient education and understanding

·         Provide healthcare team knowledge and training

·         Take concrete actions

·         Track, monitor, and report clinician and team engagement

·         Establish accountability

The NQF playbook also touched upon the issue of reimbursement for shared decision-making.

“Payment is a strong incentive to stimulate change,” the playbook summary explained. “While some employers and health plans currently pay for SDM, others could consider reimbursing for SDM and advancing the use of patient decision aids that meet the National Standards for the Certification of Patient Decision Aids.”

NQF developed the playbook in partnership with the NQF Shared Decision Making Action Team. The team consisted of public- and private-sector healthcare professionals. These team members also served on an informative panel that included patient partners, clinicians, healthcare organizations, specialty societies, and federal agencies.

As healthcare evolves to become more patient-centric, healthcare professionals are tapping strategies for integrating the patient into care. NQF has asserted that shared decision-making is not only a good tool for patient-centered care, but an essential part of a quality care encounter.

“Only by working in partnership can clinicians and patients identify patient values, goals, and preferences and make informed decisions about treatment and care,” NQF wrote in the summary of its playbook. “This model of two-way communication—known as shared decision making (SDM)—is critical to improving person-centered care.”

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