IMPLEMENTING COLLABORATE: A MEASURE OF SHARED DECISION MAKING

Purpose:

CollaboRATE is a three-item patient-reported measure of shared decision making (SDM) designed for use in routine practice. This study reports on the first implementation of CollaboRATE in clinical care. The purpose of this study was to assess the impact of delivery mode on CollaboRATE scores, response rate, and representativeness of the respondent population.

Method:

Eligible participants were all adult patients visiting a primary care clinic in Lebanon, NH. CollaboRATE was administered to patients within 24 hours of their clinical encounter via one of two modes: 1) paper in clinic, administered by staff; or 2) online patient portal. Each mode was implemented in the clinic for up to three months with data collection beginning in April 2014. For each mode, we calculated the response rate, the representativeness of respondent socio-demographics, and the rate of SDM reported by CollaboRATE. 

Result:

During paper delivery, 542/4692 patients (11.6%) completed the survey. During portal delivery, 1019/4939 patients (20.6%) completed the survey, which represented 1019/3015 patients (33.8%) with portal accounts. The respondent population was representative of the broader clinic population in terms of gender for both paper and portal delivery. Respondents were older than non-respondents in both modes. In the paper delivery of CollaboRATE, the rate of SDM reported was 80.8%, ranging from 72.3% to 93.2% per clinician. In the portal delivery of CollaboRATE, the rate of SDM reported was 71.2%, ranging from 58.9% to 82.8% per clinician. While a significantly higher rate of SDM was reported in paper delivery than portal delivery (x²(1)=16.57, p=<0.0001), the rank order of clinicians by rate of SDM reported was similar across both modes.   

Conclusion:

Patient portal delivery of CollaboRATE appears to achieve more promising response rates than paper delivery in clinic. Rates of SDM were lower for portal collection, although whether this is an effect of delivery mode or systematic differences in the respondent sample is unclear. Additional research is underway to evaluate three alternate modes of delivery: 1) Interactive Voice Response call; 2) text message; and 3) tablet computer in clinic, administered by research assistant.