Does Shared Decision-Making Reduce Health Care Costs and Utilization?

Shared decision-making (SDM) and patient decision aids (PtDAs) can lower health care costs, lower utilization, and increase prevention-related care; however, these outcomes are not always guaranteed, according to the results of a recent study presented during the 2021 Pharmacy Quality Alliance Annual Meeting.

In the session, which was presented virtually on May 11, Theresa Schmidt, vice president, Discern Health, and Kimberly Westrich, vice president, Health Services Research, National Pharmaceutical Council, discussed the findings from a systematic review assessing the effects of SDM and PtDAs in a broad range of settings.

Prior experience shows that SDM can improve both quality and experience, according to Westrich. This is because SDM has a number of patient-centered benefits, such as increasing patient satisfaction and reducing decisional conflict. Many stakeholders also assume that SDM will reduce health care costs, especially as some interventions may help patients elect more appropriate care and promote treatment adherence.

The systematic review aimed to provide a comprehensive understanding of the existing body of evidence around SDM outcomes.

Schmidt explained how the research team defined both SDM and PtDA in literature selection. SDM is defined as the process by which clinicians work with patients to explore care choices, benefits and risks, goals and preferences, and jointly make informed care decisions. PtDAs are defined as evidence-based tools designed to educate patients; this can include paper handouts, videos, or web-based platforms. Although PtDAs can be used in conjunction with SDM, “on their own they don’t count as SDM,” Schmidt said.

Overall, SDM must include collaboration between the patient and provider to make decisions, she added.

For the review, the investigators searched PubMed for articles relating to SDM and PtDAs that reported on cost and utilization outcomes. They focused on articles published between 2010 and 2019.

Outcomes were classified into 3 main categories:

• Cost: Includes component costs and total cost of care
• Utilization: Resource-intensive services such as cardiac screening or discharge to high-cost settings
• Prevention-related care: Outcomes involving a process that could prevent future adverse outcomes or utilization, such as end-of-life planning/hospice, cancer screening, or mental health-related utilization

According to Schmidt, the majority of the articles showed a favorable decrease in cost and utilization, and increase in prevention-related care. However, there were mixed findings, indicating that SDM and PtDAs do not always lead to these outcomes.

“While the majority of the articles did present favorable outcomes, a greater majority assessed at least 1 relevant outcome where no significant difference was observed,” Schmidt explained. This is likely because articles often included multiple outcomes.

One of the favorable outcomes that appeared to be impacted was medication adherence. Nine of the 12 studies that measured adherence showed outcomes with favorable increases, according to Schmidt. Eight studies showed no significant difference.

“Adoption of [SDM] can lead to a greater potential patient-provider bond,” Schmidt said. She added that informed patients who are engaged in choosing their own treatment are more likely to have a better understanding of what to expect and less surprised by adverse effects, and therefore more likely to adhere to their medications.

In the context of value-based care, Westrich explained that the mixed results suggest that these interventions may be critical for patient-centered care, but will not always lead to reduced care. However, this does not mean that they do not add value, she said. SDM can increase patient satisfaction and knowledge, reduce decisional conflict, and improve overall experience and outcomes.

“Our results reinforce the value of these interventions for improving medication adherence,” Westrich said.

Although SDM may not be a panacea for reducing health care costs, implementing these interventions can provide value in other areas and still have the potential to reduce costs and utilization.

Reference

1. Schmidt T, Westrich K. The impact of shared decision-making on cost and utilization and implications for value-based care. 2021 Pharmacy Quality Alliance Annual Meeting; May 11-17, 2021; virtual. Accessed May 12, 2021.