Method: Primary care physicians at Massachusetts General Hospital (MGH) have access to 39 PtDAs developed by the Informed Medical Decisions Foundation. Physicians can order the decision aids through the electronic medical record (EMR) and the PtDAs are mailed to patients at their home. We developed a 45-minute training session that addressed the integration of shared decision making in routine care, models for implementation of PtDAs, and practice- and provider- level data on PtDA usage. Each session also left time for discussion of best practices and implementation challenges specific to the practice. We scheduled training session with each primary care practice during regularly scheduled team meetings.
We examined the impact of training in a before – after study. We tracked PtDA orders through our EMR at each practice the 8 weeks prior to each session and compared that to the 8 weeks post. We examined changes in overall prescriptions and unique prescribers in the pre- and post- intervention periods using Wilcoxon signed rank test.
Result: We conducted sessions with 14/15 primary care practices and have complete, follow-up data on 11 practices. Almost 200 clinicians attended the sessions. The training was associated with a more than doubling of PtDA orders for the practices (mean orders: 29 in the 8 weeks pre- versus 73 in the 8 weeks post-training, p= 0.01). The training also led to an increased number of unique prescribers (mean number per practice: 6 pre-training versus 10 post-training, p=0.02). Data from practices that had early sessions suggests that the increases may be sustained over several months.
Conclusion: Clinician training resulted in a significant increase in the use of decision aids and the number of prescribers. Getting clinicians to use PtDAs regularly is an important step to improve quality of decisions at our center.