Health Care Authority certifies first patient decision aids
Washington is first in nation to formally review, certify and advocate use of aids to help patients make decisions about their care
OLYMPIA – Rena Ortigoza had an important decision to make and she couldn’t put it off for long.
The Kirkland mom and her husband were expecting their third child, a boy. Her first child had been delivered surgically, by cesarean section. But two years later, when her second child was born, Ortigoza did not need a cesarean.
“Being that I had had a successful delivery both naturally and surgically it was hard for me to decide whether to have surgery again or whether to go naturally,” Ortigoza said. “I was looking up information on the internet, looking at blogs, and websites like WebMD, but I didn’t feel like I was getting answers. I thought they were so generalized.”
Ortigoza mentioned her dilemma to her supervisor at Group Health Cooperative in Seattle, where she is an administrative coordinator for clinical improvement. Ortigoza was put in touch with a team at Group Health that happened to be working on materials for moms in her situation.
“When the team offered me the draft of what they wanted to publish it was so helpful and really put me at ease with my own decision,” Ortigoza said.
Washington is taking steps to help health care consumers gain access to reliable sources of information so they can talk with their providers before making decisions about their care. Today the Washington State Health Care Authority (HCA) announced certification of four patient decision aids (PDAs), making Washington the first in the nation to formally review, certify and advocate the use of high-quality decision aids.
“I believe shared decision making is fundamental to the patient-clinician encounter. It is as fundamental as providing evidenced-based, appropriate clinical care,” said Dr. Dan Lessler, HCA chief medical officer. “Everything we are doing to transform practice has to do with assuring that people are getting the highest quality care that conforms to the best available scientific evidence and to the values that the patient brings to the encounter.”
With a grant from the Gordon and Betty Moore Foundation, staff at HCA worked with key state and national stakeholders to develop a process to certify high quality patient decision aids. Implementing the use of certified decision aids, as well as providing training to support the spread of shared decision making, is supported through a State Innovation Models (SIM) grant from the Centers for Medicare & Medicaid Innovation (CMMI).
The certification criteria are guided by the work of the International Patient Decision Aid Standards (IPDAS) Collaborative, addressing content, development process and effectiveness.
In April, HCA invited developers of PDAs to submit tools on maternity, labor or delivery. HCA pays for 50 percent of births around the state through Apple Health (Medicaid) and the Public Employees Benefits Board (PEBB) Program.
In 2007, Washington became the first state to pass legislation around shared decision making when the Blue Ribbon Commission bill (Chapter 259) enacted a shared-decision making pilot. The legislation also provided that if a provider uses a certified decision aid as part of the informed consent process that there is a presumption that informed consent has been given and obtained.
HCA has called for use of PDAs in its contracting with health plans. At least one of its health plans was already on board.
“I use them all the time. Patient decision aids allow me to have a very different discussion with my patients,” said Dr. Matt Handley, Group Health medical director for quality. “Decision aids do a better job than I can at helping patients understand their options. I then have more time to explore the issues that matter most to them and understand how their condition impacts their lives.”
Group Health started using decision aids to support shared decision making in 2009 for preference sensitive surgical conditions, such as hip and knee arthritis, benign prostate conditions, and fibroids. Group Health has used decision aids with more than 55,000 of their patients.
“Our experience is consistent with the published literature. Patients love the model of shared decision making. More than 90 percent would recommend using decision aids to other patients in similar circumstances,” Handley said. “PDAs do an excellent job at risk communication, helping patients get a clear understanding of the benefits and risks of different treatment options, including choosing not to pursue definitive treatment.”
For Ortigoza, the PDA delivered peace of mind as she proceeded with a surgical birth for her son. “The PDA did answer some questions I’d had in my own head,” she said. “When I talked to my husband and went back to talk to my providers I felt absolutely comfortable with my decision.”
Healthier Washington, a multi-agency, cross-sector initiative is supporting the use of PDAs and shared decision-making through a number of engagement activities. Information about the decision aids certified by the HCA is at www.hca.wa.gov/hw.
The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.