by Amyn Amlani, PhD
Healthcare has moved towards shared decision-making as an engagement strategy that allows providers and patients to work together in determining treatment intervention and management. Decision aids are part of the shared decision-making process that encourages active participation by patients in their healthcare decisions. Over the past few months, readers have been introduced to the application of decision aids, as well as the implementation and effectiveness of adopting various models and tools of decision aids into clinical workflow.
In this month’s blog, we evaluate the implementation of decision aids in clinical practice, and what that means to service delivery with the market evolution happening in the hearing care space.
Shared decision-making is the act of educating patients about their treatment and management options, presenting them with the benefits and limitations of each option, and ultimately allowing them to decide, along with their family members and care providers, on their healthcare needs.
While this patient engagement strategy appears to be intuitive, the reality is it is not yet used widely throughout the healthcare industry, including the hearing care space. Below are common themes reported by providers.
Implementation Barriers – Time constraints, limited reimbursement structure, limited tools to facilitate shared decision-making, and a lack of clarity regarding an accepted framework of shared decision-making has kept many healthcare providers from adopting the strategy in any meaningful way.
In 2018, the National Quality Forum (NQF)—a US-based non-profit organization that promotes patient protections and healthcare quality through measurement and public reporting—called for healthcare experts and policymakers to integrate shared decision-making as a standard of care. This call to action resulted in the publication of guidelines for best practices for shared decision-making to help educate providers on how to employ shared decision-making as a patient engagement strategy.
Switching Costs – There are monetary, psychological, effort-based, and time-based costs associated with transitioning from the traditional patient engagement model to patient engagement using a decision aid. A systematic review found that incorporating decision aids into routine practice would result in additional switching costs for developing materials, and in labor and training for providers and staff.
There is also the increase in time and labor associated after implementation. Healthcare, in general, found that employing a decision aid increased patient consultation times by about 3 minutes compared to the incorporation of shared decision-making. On the other extreme, such as the clinical care of cancer patients, providers and staff expended greater time during the clinical encounter, an average of 65 minutes per patient, compared to the traditional standard of care.
Cost Savings – Decision aids offer the potential of reducing costs in the long term. In healthcare, roughly 1-in-5 patients provided with decision aids opted for less-invasive procedures and more conservative therapies. A study prepared by the Commonwealth Fund predicted that the implementation of a decision aid could yield a net savings of >$7 billion over a 10-year period in US health spending.
For patients, the benefit is improved quality of care. To reiterate the study reported in last month’s blog on implementation and effectiveness, decision aids improve quality of care as reported in the 2014 Cochrane review.
The report revealed that decision aids provided patients with enhanced information allowing them to make better choices regarding potential interventions compared to patients who received usual care (i.e., provider counseling). The enhanced information yielded:
- an increase in patient knowledge and understanding of the harms and benefits of various treatment interventions,
- increased and accurate perceptions of risks,
- greater comfort with their treatment decision, and
- a reduction in patient’s delaying treatment.
Decision aids offer the potential to improve health outcomes by presenting complex information in a manner that allows providers and patients to work together in determining treatment intervention and management. This service engagement model promotes an effective dialogue between provider and patient, and builds a robust value-based care environment, and should lead to increased patient benefit and satisfaction.
The hearing care market is evolving from its traditional service model to one where patients will be offered increased latitude in deciding their hearing care needs via non-personnel support channels. This shift to consumerism is expected to increase accessibility and affordability to a historically stagnate market. The integration and availability of a decision aid in clinical practice offers providers opportunities to educate patients about their professional value, and create a long-term relationship where patients’ hearing needs are treated and managed long-term.
As healthcare, in general, is calling for healthcare experts and policymakers to integrate shared decision-making as a standard of care, the hearing care space would be remiss not to follow suit. For shared decision-making to be successful in hearing care, providers must first be willing invest the necessary time to be educated on how to deploy decision aids. This shift towards patient-centered care in the evolving market will also require that providers re-assess those services—diagnostic, treatment, and management—they offer, and how best to manage these offerings as it relates to market needs and potential revenue streams.
As clinical interactions become a more balanced process, the industry will have the opportunity to realize, firsthand, its true potential.