Shared Healthcare Decision-Making — April 2017

Shared Healthcare Decision-Making — April 2017


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How to Improve Outcomes and Decrease Costs

Numerous studies performed in the last 10 years suggest that patients who actively participate in making healthcare decisions with their doctors report greater satisfaction with their care, better outcomes and lower costs. For example, a study reported in Health Affairs of 33,163 patients at a large healthcare facility in Minnesota showed that better informed patients cost less to treat. In the first year of the study, knowledgeable patients had 8% lower treatment costs, and, in the first half of the following year, 21% lower costs, than less involved patients.

The New England Journal of Medicine explains that shared decision-making can offer benefits for patients, providers and the healthcare system in general: patients have increased knowledge and less anxiety about the care process, care is better aligned with patients’ values and preferences, variations in care and costs are reduced, and health outcomes are improved.

Shared Decision-Making

Shared-decision making is a collaborative process between patients and their healthcare providers to make important decisions together. It considers the best clinical evidence, the risks and benefits, as well as patients’ personal needs and circumstances. The goal is making decisions that both providers and patients support to achieve outcomes that are best suited for the patient. Shared decision-making is an example of patient-centered care, and is known to result in greater adherence to a care plan and benefits all patients, regardless of their education or age.

Medical decisions are often complex; they can have no single “right” solution or clear advantage. The best decision for one person might be entirely different for another. At a time when more than one-third of healthcare delivered is considered unnecessary and provides no benefit to the patients who receive it, being part of the decision-making process couldn’t be more important.

Becoming Better Informed

  • Patient-friendly resources on a variety of topics are available from Choosing Wisely. See the link for Spanish language versions.
  • Your KnovaSolutions clinician is a resource for information and support, and can spend as much time as you need while you are learning about and evaluating your options.
  • Ask the 5 Questions (at the bottom of the newsletter) for every healthcare decision or situation.

Case In Point

Tim suffered from long-term back pain that he had managed with stretching, strengthening exercises and over-the-counter pain relievers. One day he experienced severe pain while gardening. After some time of treating his pain his usual way, he saw an orthopedic surgeon who ordered a MRI, diagnosed degenerative disk disease and recommended spinal fusion surgery.

Tim didn’t want to consider surgery yet and, on a co-worker’s suggestion, called KnovaSolutions. His KnovaSolutions nurse explained that he had other treatments options besides surgery, such as nerve injections, neuropathic pain medications, complementary therapy and physical therapy. They discussed the pros, cons and possible outcomes of each option. She encouraged him to discuss this information with his primary care provider (PCP) so they could apply it to his particular situation. Tim and his PCP agreed on a care plan; he would have a steroid injection and start physical therapy. After 4 weeks, he reported being nearly pain-free and back to normal activities.

Tim admitted that he could have saved time and money by going to his PCP first, rather than starting with a surgeon. But he felt that he dodged a big bullet by avoiding surgery. Besides its cost, he would have missed time from work, experienced a painful surgery and recovery process, and been exposed to numerous risks from the surgery itself (potential nerve damage, bleeding, and no improvement in his condition). All of these things would have affected Tim AND his family who would have needed to step in and help out.

The success of Tim’s story lies in how he engaged in the process, starting with his preference to avoid surgery. He learned about his options and made an informed, shared decision with his PCP that felt right to him. Compared to surgery, his decision was far less costly, had fewer risks, and didn’t involve extended time off from work or increased demands on his family.

There are many other ways that a shared decision-making relationship with your provider can help protect you. You may be able to:

  • Identify and treat hidden/early health concerns through preventive screening before they develop into larger problems requiring more advanced care.
  • Learn about alternative, less invasive, testing and treatment options.
  • Avoid exposure to radiation from imaging tests (x-rays and CT scans) that won’t change the outcome or provide enough additional information to warrant the risk or expense.
  • Use recent test results rather than have repeat testing (more exposure to radiation or other side effects, time away from work and cost).
  • Avoid optional procedures or tests you don’t want, won’t ensure results, that pose risks you aren’t willing to take, are costly, and/or have the potential to do harm.
  • Better commit to your care plan because your opinions and preferences have been heard, respected and implemented.
  • Enjoy satisfaction with the outcome of your decisions and a strong relationship with your provider.

Providers also benefit from shared decision-making relationships with their patients. They too enjoy satisfaction that they are doing good work, which can inspire them to continue to provide quality care.

Questions to Ask Before Any Test, Treatment or Procedure

  1. How will this test or procedure help? What are the potential results and how will they affect the next steps?
  2. What are the risks and side effects?
  3. Are there simpler, safer options?
  4. What if I choose to wait or choose not to have the test?
  5. How much does it cost, and does insurance usually cover it?

At whatever point you are in the process of making healthcare decisions, KnovaSolutions can help. Your nurse can offer information and support as you develop a strong relationship with your PCP. Call us at 800/355-0885, M-F, 8 am-5 pm.

Click here to view/download the full newsletter. We encourage you to leave a comment or question below and a KnovaSolutions nurse or pharmacist will reply.

The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider.  If you have concerns about your health, please contact your healthcare provider.


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