Shared decision-making (SDM), a collaborative process in which patients and providers make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient's values and preferences, is being increasingly advocated as the optimal approach to decision-making for many health care decisions. The rapidly paced and often chaotic environment of the emergency department (ED), however, is a unique clinical setting that offers many practical and contextual challenges. [reference: Hess EP et al. Academic Emergency Medicine, 2015, volume 22, issue 7, pages 856-864]
Our long-term goal is to promote evidence-based patient-centered approach and evaluation in the acute setting to more closely tailor testing to disease risk, reduce unnecessary diagnostic testing, and improve patient engagement in healthcare decisions in the Emergency Department.
Erik P. Hess, M.D., and our team are evaluating the utility of a decision aid in patient engagement and rates of cardiac stress testing for patients with chest pain in the emergency department.
This PCORI funded study had the objectives of testing if Chest Pain Choice improves patient-centered outcomes and decreased health care utilization in four diverse hospital EDs, taking into account patient values, preferences, and circumstances.
To accomplish this objective, we compared Chest Pain Choice to usual clinical care using risk stratification tools and a decision aid to:
This study was completed this year, and the abstract was presented at the American College of Cardiology Scientific Session in Chicago, IL, April 2016.
We found that the use of the decision aid increases patient knowledge, engagement and satisfaction without increase in adverse events. Hospital admissions, cardiac testing and health care utilization may also be reduced.
Trial registration: NCT01969240.
We are evaluating the utility of a decision aid in patient and parent engagement and rates of head CT imaging for children with head trauma in the emergency department.
This PCORI funded ongoing study aims to:
This is a multicenter clinician-level parallel randomized trial that compares an intervention group receiving a structured risk assessment and corresponding decision aid (Head CT Choice) to a control group receiving usual care.
This study is still enrolling, and it very close to completion.
Trial Registration: NCT02063087