Moving to value-based models of care will require us to include our patients in decision making in ways we have not done before. Historically healthcare has focused on first doing no harm, which has led us to err on the side of being conservative and has thus led to increased utilization of services. As we move to models where consumers are more responsible for the cost of this care, including them in decisions that impact their cost and care will become increasingly important.
In a randomized clinical trial in Circ Cardiovasc Qual Outcomes, headed by Erik Hess, MD of the Mayo Clinic, researchers compared usual care for a cohort of patients to a cohort receiving the Chest Pain Choice decision aid intervention. The primary outcome, selected by patient and caregiver representatives, was patient knowledge. Secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, and the 30-day rate of major adverse cardiac events. Results showed that the decision aid improved patient knowledge of chest pain symptoms, increased patient engagement in the decision-making process and helped patients better assess their own 45-day risk of acute coronary syndrome. This led to a decrease in admissions for observation, decreased stress testing and increased engagement in decision making, with no difference in cardiac events.
This study is a great example of how including the patient in the decision making impacts their perception of value. Tools such as the Chest Pain Choice not only help educate what the decision is truly about, but will also help the healthcare delivery system realize that the consumer can be engaged in a manner that helps them share in the decision.
As we further develop such models, those we serve will become more engaged and activated in their health and well-being. We have historically sidelined our patients in such decision making. Another component of this increased engagement is due to the individualization of care. Patients want the best, but they want it in relation to them as individuals. I want the information, but I want it in relation to my particular situation. That allows me to better understand the decisions needed to be made by me, in a context that is about me, working with my physician as a trusted partner.
We need to continue to work within the framework of such behavioral economics. Only in such a manner will we truly deliver on value to those that are in our care. Let us learn from each other, and from those we have been called to serve. As Hess said, “When patients are involved with their care decisions, it is more likely they will get the right care for their concerns. We believe that the Chest Pain Choice decision aid will make it easier for patients and physicians to have a thoughtful discussion and make an individualized care plan that is less likely to overuse unnecessary services.”