Developing and implementing decision support at the Palo Alto Medical Foundation
How can shared decision making (SDM) and patient decision support interventions (DESIs) be adopted in community-based, fee-for-service organizations such as the Palo Alto Medical Foundation (PAMF)? Researchers and clinicians at PAMF have initiated efforts to promote SDM and incorporate DESIs into practice for over five years. DESIs, encompassing a variety of disorders, produced by external developers, along with home-grown interventions aimed at improving patient-physician communication, have been tested in PAMF clinics with over 3000 people. Valuable lessons have been learned. Direct observation of visits suggests SDM can be facilitated at the point of care in primary care settings. Yet, there is a complex relationship between patient knowledge and screening choices. Meaningful stakeholder engagement and integration into standard work are prerequisites for implementation. Many clinicians are not ready to ‘pull’ DESIs into their workflow. Financial, organizational, and cultural changes are needed, and DESI design can be improved for real world practices.
Keywords: Shared decision making, point of care, patient knowledge, provider readiness, organizational structure, financial incentives, fee-for-service organization, meaningful stakeholder engagement, direct observation, standard workflow
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