Candidate for the Lee B. Lusted Student Prize Competition
Purpose : Compare the relative importance of shared decision making to other factors that influence a patient's choice of a specialist for consultation.
Methods: We recruited a national sample designed to roughly parallel US population demographics using an Internet survey vendor. Adults who reported having a visit to a healthcare provider in the past year were invited to complete a web based adaptive conjoint analysis (ACA) survey consisting of 8 attributes with 3 levels each. We performed data quality control by excluding participants that did not spend an adequate time on each page or who consistently selected one response. We estimated individuals' utility (overall preference) for each level of each attribute using hierarchical Bayesian analysis and then normalized the weights based on the observed ranges of utilities for the attributes. We simulated patient choice for different types of specialists using a randomized first choice method. Survey data collection and analysis was completed using SSIWeb and ACA/HB (Sawtooth Software).
Results: 706 patients completed the survey. Of these 530 had adequate data quality as defined by time on page for responses and variability in response items. Subject demographics paralleled those of the US population (53.5% female, 31.1% minority, 9.4% Latino) but were better educated (82.5% with some college or higher). Their health was somewhat lower than typical of the population (17.6% reported poor to fair health). Not surprisingly, the most important factor in patients' choice of a specialist was cost of out of pocket cost (insurance coverage). However, among the non financial factors, EHR interoperability and communication between specialist and generalist had greatest weight (P <0.001) followed by the specialist's decision making style (P< 0.001 for differences, see figure). In model simulations, two thirds of patients (67%) were willing to trade two weeks of time waiting for an appoint with a specialist that participates in shared decision making.
Conclusion: Coordination of care with the primary care providers and decision making style (shared decision making) are highly valued by patients in the choice of a specialist for a referral—more valued than attributes such as specialist availability, expertise, and travel time to the specialist. Generalists should consider patients' preferences when recommending a specialist to patients for a referral.
See more of: The 35th Annual Meeting of the Society for Medical Decision Making