Developing and Evaluating a Clinic-Based Decision Aid Delivery System.

Area of Science:

• Health Services Research
• Quality Improvement in Healthcare
• Patient Education

Background:

• Decision aids (DAs) offer benefits but face low adoption in clinical practice.
• Quality improvement methods can integrate DA delivery into primary care workflows.
• DA uptake involves patients actively engaging with educational materials.

Purpose of the Study:

• Develop and test multiple DA delivery processes with clinic staff.
• Implement a systematic approach to measure DA delivery and patient uptake.
• Compare patient uptake and satisfaction across different DA delivery models.

Main Methods:

• Employed a microsystems approach to implement three DA delivery models: integrated disease management, physician referral, and mail distribution.
• Utilized an electronic health record-linked database and tracking tools for monitoring.
• Designed clinic-based processes to measure DA uptake and patient satisfaction.

Main Results:

• 1144 DAs were delivered; 51-73% of patients returned within 6 months.
• Nurse-led follow-up indicated 65-79% patient recall of DAs.
• Patient uptake ranged from 23-27%, with high satisfaction reported (82-93%).

Conclusions:

• Clinical realities include variable follow-up rates (25-33% missed visits).
• DA uptake was modest but consistent across tested delivery methods.
• Multiple strategies exist for implementing decision aids in primary care settings.