Strategies to implement shared decision-making in the emergency - PowerPoint PPT Presentation

Strategies to implement shared decision-making in the emergency department Erik P. Hess MD MSc Pat Dunn PhD FAHA Professor of Emergency Medicine Senior Program Manager University of Alabama at Birmingham Center for Health Technology & Innovation @ErikHessMD American Heart Association November 2, 2018 #PCORI2018

Disclosures • Research funded by PCORI 2

Clinical Conundrum 3

Chest Pain Choice Multicenter Trial (n=898) Outcome Change ↑ Patient knowledge ↑ Patient engagement ↓ (16%) Placed in EDOU for stress testing ↓ (8%) Stress testing within 30 days ↑ Provider experience ↑ Outpatient follow-up ↔ Safety Hess, Montori et al. BMJ 2016

Implementation strategies • Assemble implementation team • Perform organizational context assessment • Integrate HEART score and decision aid into EMR and clinical workflow • Design toolkit for dissemination 7

Assemble Implementation Team 8

Organizational Context Assessment How Appropriate/Feasible/Acceptable do you think it is to implement Chest Pain Choice in your organization right now? Not at All 1 2 3 4 5 6 7 8 9 10 Very 9

Integrate HEART Score and Decision Aid into EMR

Opens HEART Score form, link to risk- appropriate DA, print

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Insert text in clinical note

Design Toolkit for Dissemination 15

Evaluation plan • Formative • Focus groups and clinician surveys at 3, 6, 9 and 12 months • Summative: RE-AIM framework • Reach • Effectiveness • Adoption • Implementation • Maintenance 16

How do you get implementation sites on board? • Ask questions, LISTEN • Time implementation to organizational readiness • Lay site-specific groundwork • UAB: Develop outpatient chest pain evaluation pathway • Kaiser: Site-specific risk estimates for DA, Tailor outpatient management options, integrate in EMR • Mayo: phase III 17

Implementation Challenges • Rapidly collaborating to set-up outpatient chest pain evaluation pathway at UAB • Knowing when to delegate • Standardization versus customization? 18

Patient Roles 19

American Heart Science Translation Association Multi-disciplinary Professional Education Courses, Scientific Dissemination strategy Conferences & Events with reach to global audiences Science Discovery Strategically Focused Research Networks, Diagnosis or Scientific Statements Acute Event and Guidelines, Scientific Journals Quality & Systems Improvement programs At Home Care Transitions Community Programs, Educational tools – print Volunteer Navigators and digital, Self- Management Platforms

Health literacy – Shared decision making model

Thank You! Erik P. Hess MD MSc Pat Dunn PhD FAHA Professor of Emergency Medicine Senior Program Manager University of Alabama at Center for Health Technology & Birmingham Innovation @ErikHessMD American Heart Association 22