Last month, we announced a major new partnership with the Foundation for Informed Medical Decision Making. The Shared Decision Making Maternity Initiative will bring high-quality, field-tested, evidence-based decision aids to all women considering their pregnancy, birth, and postpartum care options. Shared decision making (SDM) is a new concept for many in the maternity care world, and maternity decision making is a new area for the SDM community, so we decided to dig a little deeper into the issues with the Foundation’s Director of Policy and Outreach, Lyn Paget, MPH. Many thanks to Lyn for being the TMC Blog’s first Leading Change interview subject. We talked about why the time is right for maternity care SDM, what SDM looks like in action, and why any SDM strategy must address and overcome system barriers.
TMC Blog: The Maternity Initiative represents a major expansion into a new clinical area for the Foundation for Informed Medical Decision Making, and it will engage new partners in both the development and dissemination of the tools. Why did the Foundation decide to take on maternity care decision making? What are the major opportunities you see for this project?
Lyn Paget: For over two decades the Foundation has developed evidence-based patient decision aids that include accurate, unbiased and understandable information about important choices in medical care and treatment. We know from years of study that these tools benefit both the patient and the caregiver when used in a shared decision making process. One of the unique elements of the Foundation’s work has been our focus on the decision maker, the person who faces these choices and who will live with the outcomes of that decision. Of paramount importance to us are the personal preferences of that individual. We believe those unique goals and concerns should be acknowledged in every medical decision.
Extending our expertise into the world of maternity in partnership with Childbirth Connection is a timely and meaningful endeavor for the Foundation. The increased recognition of the importance of shared decision making combined with the thoughtfully prepared objectives specific to maternity decisions in the 2020 Vision for a High-Quality, High-Value Maternity Care System creates a powerful opportunity to harness the expertise needed to achieve this vision. The concerns of overuse and underuse in maternity care services that lead to unjustified variations across the country build the solid rationale for creating an accessible and trustworthy source of information on which all women can depend.
TMC Blog: So as you mentioned, the Foundation’s tools are used in the context of a “shared decision making process”. What does this process look like and how does the Foundation work to ensure the process is an effective one?
Lyn Paget: Our interest in learning how best to support patients facing choices led the Foundation to establish a research agenda to expand our knowledge and understanding of the value of decision support among diverse patient populations and health care settings. In addition to funding a wide variety of projects to enhance the science of patient decision making, the Foundation supports clinical demonstration sites across the country. These clinical settings develop protocols to identify patients, educate staff, incorporate the use of decision aids and shared decision making, and evaluate their progress. What we learn from these models is key in encouraging widespread adoption of shared decision making.
The value of an informed and involved patient seems intuitive, but it is certainly a shift in the typical paradigm most of us experience in medical care. The most fascinating stories from these sites are the ones that give us real insight into what this process looks like and what it means for patients and caregivers. We recently interviewed several of the clinicians involved with shared decision making and here are some of their stories.
TMC Blog: What’s the Foundation’s process for developing a decision aid? How do you ensure quality, get the messages that will resonate, and make sure the tools reflect current best evidence?
Lyn Paget: The Foundation’s process is unique in its rigorous attention to the accurate evidence and its focus on the individual needs of every decision maker. It is a combination of multiple professional teams including highly talented evidence staff, evaluation and production experts, and professionals who focus entirely on gathering the insights and perspectives of patients making medical decisions. The union of these complementary sources of information guides the development of our patient decision aids. The process is described in more detail here.
TMC Blog: Childbirth Connection’s Milbank Report, Evidence-Based Maternity Care and the multi-stakeholder Blueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System identify many barriers to the provision of woman-centered, evidence-based care. Many of these are not unique to maternity care. Can you talk about how your organization addresses system barriers? What are the policy and advocacy priorities for ensuring the success of the Maternity Initiative?
Lyn Paget: Part of the appeal for the Foundation is precisely this aspect of the Maternity Initiative. Our work to catalyze a sustainable model for shared decision making includes advancing policy and legislation, impacting quality measurement, and disseminating research and proof of concept evidence. By joining forces with Childbirth Connection, we see a partnership that will focus not only on the development of high quality decision support for women, but the development of a strategy to overcome barriers to access evidence-based information. We plan not only to work with policy leaders to advocate for policy advancement, but to create an access model for all women regardless of where and how they enter our health care system. It will be imperative that we work with key stakeholders to assure this equal and comprehensive access.
TMC Blog: The Affordable Care Act includes provisions related to shared decision making. Can you tell us a little about those provisions and any progress toward implementation?
Lyn Paget: Section 936 of the Affordable Care Act is called “The Program to Facilitate Shared Decision Making” and it specifies four areas of focus:
- Produce patient decision aids
- Set quality standards and certify decision aids
- Create Shared Decision Making Resource Centers
- Grant funds to providers for development, use and assessment of SDM techniques using certified decision aids
In addition to this section, the Centers for Medicare and Medicaid Innovation Center (CMMI) has prioritized shared decision making and we anticipate that CMMI will begin funding providers as one of the several options outlined in the reform legislation: assisting applicable individuals in making informed health care choices by paying providers for using patient decision support tools that improve individual understanding of medical options.
Interested in hearing more from Lyn Paget? Check out our TMC Topics Webinar, Implementing Shared Decision Making in Maternity Care.