Faced with an array of treatment options, many patients would choose to forgo invasive surgeries for kinder, gentler treatment, such as physical therapy for a painful disk. But according to Paul Sherman, M.D., medical director for care systems development at Group Health, patients get funneled toward elective surgeries at every step of the care process.

"Surgeons want to perform surgeries, and physicians don't have the same perceptions as patients when it comes to down-sides to elective procedures," he said during a June 16 presentation at the AHIP 2011 Institute in San Francisco. "In fact, studies have shown that physicians recommend much more invasive treatments for their patients than they would choose for themselves. So there's definitely a disconnect there."

Washington State is one of three states that mandate the shared decision process, which requires patients to be informed about the different treatment options available to them. Group Health, a hybrid multi-specialty practice/health plan based near Seattle, has inserted shared decision aids into the care process a few years ahead of that mandate, but didn't do it very well, Sherman said. "We produced videos that we handed out to physicians to show patients who were candidates for elective surgeries, but it was a pain for them to find the time to play the video for a patient, so we didn't make much progress. We didn't work it into the process."

A few years ago Group Health tried a different tack. It launched a service that put videos for 12 common elective surgeries online. Physicians now can embed links to the videos--created by Boston-based Health Dialog-- into patients' electronic charst, which patients can access online, or send them the link to a video through secure e-mail. A link also can be added to referrals sent to specialists.

The decision aid video links have been given to 11,000 patients, 6,000 who are being treated by Group Health orthopedists. While Sherman declined to provide details on the impact of the program, citing the impending publication of the results in a medical journal, he did tell the audience that the Group Health CEO has publicly stated that elective surgeries for those 12 conditions have decreased by 10 percent to 12 percent.  "Those decreases are happening even though we're only getting those decision aids in front of about half the patients who are considering elective surgeries, so the impact has been huge."



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