Purpose: Patient decision aids (DAs) have been shown to help patients make informed healthcare decisions. Dashboards were developed as a business intelligence tool to monitor key performance indicators and provide insight into day-to-day operations. Our goal was to develop a dashboard that incorporates shared decision making (SDM) measures to monitor the effect of DAs on patient decision making in routine clinical care.
Method: Eligible patients are systematically referred to the Center for Shared Decision Making at Dartmouth Hitchcock Medical Center for decision support programs. Participants: 1) complete pre-DA questionnaire, 2) watch a condition specific video DA, 3) complete post-DA questionnaire. Measures: DA loan tracking (checkout/return dates, referring department/provider, distribution method), pre/post-video intention, and multiple choice knowledge quiz. DA topics: PSA screening, knee osteoarthritis, hip osteoarthritis, breast cancer surgery, breast reconstruction, herniated disc, and spinal stenosis. Clinical and SDM questionnaire data are summarized by topic into a single page html dashboard report and provided to clinicians on a monthly basis. The html dashboard can be e-mailed, posted on a website, or printed on paper.
Result: From November 2009 – April 2012, 7009 DAs were distributed. Across conditions, similar patterns emerged (Table 1). After watching the video decision aid: fewer patients were unsure about their decision (X2, p ≤ .05*) and most patients (65%) had acceptable knowledge scores. Historic and current DA referral counts are reported by department and provider to provide feedback to clinicians.
Conclusion: Regular reporting of DA prescribing patterns and decision process measures can be used to monitor the impact of decision aids on informed patient choice in routine care. Dashboards also have the potential to identify ‘missed opportunity’ patients that could benefit from decision aids as well act as an instrument to assess continuous quality improvement in health care.
| Table 1. DA title | DA loans - n Returned SDM Questionnaire (%) | Unsure Patients | Knowledge Score (> 68%) | |
Before DA | After DA | After DA | ||
| PSA screening | 2019 (28%) | 28% | 18%* | 89% |
| Knee osteoarthritis | 1343 (53%) | 31% | 24%* | 64% |
| Hip osteoarthritis | 758 (53%) | 26% | 23%* | 64% |
| Breast cancer surgery | 437 (53%) | 38% | 28%* | 69% |
| Breast reconstruction | 335 (45%) | 15% | 15% | 72% |
| Spinal stenosis | 1164 (34%) | 35% | 26%* | 45% |
| Herniated disc | 953 (46%) | 27% | 20%* | 49% |