PATIENT SURVEY RESULTS AFTER USE OF INTEGRATED EHR DECISION TOOL

Purpose: We investigated associations between clinical use of HealthDecision, a shared decision-making tool embedded in the medical record of an academic medical institution, with results of patient satisfaction surveys.

Method: We identified patient surveys returned for visits during which HealthDecision was used and compared results with surveys from similar patients seeing the same providers during visits not using HealthDecision. Using logistic regression, we compared survey results between groups, controlling for level of provider experience with the tool. We also compared the proportion of “strongly agree” responses for the two groups using z-tests. We evaluated survey questions related to the goals of shared decision making, as well as questions that appear unrelated.

Result: Between 2010 and 2015, 1305 different providers opened HealthDecision within charts of over 28,000 patients. Of these, 982 patients seen by 184 providers completed 1,014 surveys. By comparison, 22,681 patients seeing the same 184 providers completed an additional 30,617 surveys for visits not using HealthDecision. Patients whose visit included HealthDecision were significantly more likely to “strongly agree” with survey items related to shared-decision making, including: “I was given the chance by my provider to provide input to decisions about my healthcare,” (OR=1.26 p=.048)  “My provider answered my questions about my health,” (OR=1.29 p=.045) and “My provider showed concern and sensitivity to my needs” (OR=1.30 p=.0439). These effects remained significant when controlling for provider’s experience with the tool. By comparison, responses to questions unrelated to the visit (e.g.“My needs were handled promptly and efficiently by the office staff.”) did not significantly vary based on use of HealthDecision. The z-test produced similar results: The proportion of “strongly agree” responses was significantly higher (p<.05) for 3 provider communication questions when HealthDecision was used, compared to visits when it was not used.

Conclusion: Over 5 years at an academic medical center, use of an embedded decision tool was associated with significantly higher patient survey ratings, particularly for questions related to provider-patient communication.

While not proof of causality, the association suggests that use of HealthDecision within the clinic visit may improve the patient’s experience.  Future research should focus on how providers are using the tool before, during, and after clinic visits and investigate the reasons for the improved responses.