Barr Paul J, Forcino Rachel C, Thompson Rachel, Ozanne Elissa M, Arend Roger, Castaldo Molly Ganger, O'Malley A James, Elwyn Glyn
The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA.
Dartmouth-Hitchcock Patient and Family Advisory Council, Lebanon, New Hampshire, USA.
BMJ Open. 2017 Mar 24;7(3):e014681. doi: 10.1136/bmjopen-2016-014681.
Shared decision-making (SDM) has become a policy priority, yet its implementation is not routinely assessed. To address this gap we tested the delivery of CollaboRATE, a 3-item patient reported experience measure of SDM, via multiple survey modes.
To assess CollaboRATE response rates and respondent characteristics across different modes of administration, impact of mode and patient characteristics on SDM performance and cost of administration per response in a real-world primary care practice.
Observational study design, with repeated assessment of SDM performance using CollaboRATE in a primary care clinic over 15 months of data collection. Different modes of administration were introduced sequentially including paper, patient portal, interactive voice response (IVR) call, text message and tablet computer.
Consecutive patients ≥18 years, or parents/guardians of patients <18 years, visiting participating primary care clinicians.
CollaboRATE assesses three core SDM tasks: (1) explanation about health issues, (2) elicitation of patient preferences and (3) integration of patient preferences into decisions. Responses to each item range from 0 (no effort was made) to 9 (every effort was made). CollaboRATE scores are calculated as the proportion of participants who report a score of nine on each of the three CollaboRATE questions.
Scores were sensitive to mode effects: the paper mode had the highest average score (81%) and IVR had the lowest (61%). However, relative clinician performance rankings were stable across the different data collection modes used. Tablet computers administered by research staff had the highest response rate (41%), although this approach was costly. Clinic staff giving paper surveys to patients as they left the clinic had the lowest response rate (12%).
CollaboRATE can be introduced using multiple modes of survey delivery while producing consistent clinician rankings. This may allow routine assessment and benchmarking of clinician and clinic SDM performance.
共同决策（SDM）已成为政策重点，但尚未对其实施情况进行常规评估。为填补这一空白，我们通过多种调查方式测试了CollaboRATE的应用效果，CollaboRATE是一项包含3个项目的患者报告的共同决策体验指标。
评估在现实世界的初级保健实践中，不同给药方式下CollaboRATE的应答率和应答者特征、给药方式和患者特征对共同决策表现的影响以及每个应答的管理成本。
观察性研究设计，在15个月的数据收集期间，在一家初级保健诊所使用CollaboRATE对共同决策表现进行重复评估。依次引入不同的给药方式，包括纸质问卷、患者门户网站、交互式语音应答（IVR）呼叫、短信和平板电脑。
年龄≥18岁的连续就诊患者，或年龄＜18岁患者的父母/监护人，就诊于参与研究的初级保健临床医生处。
CollaboRATE评估三项核心共同决策任务：（1）对健康问题的解释；（2）征求患者偏好；（3）将患者偏好纳入决策。每个项目的回答范围从0（未做任何努力）到9（已尽一切努力）。CollaboRATE分数计算为在三个CollaboRATE问题上均报告得分为9的参与者比例。
分数对给药方式效应敏感：纸质问卷方式的平均得分最高（81%），IVR方式最低（61%）。然而，在使用的不同数据收集方式中，临床医生的相对表现排名是稳定的。研究人员管理的平板电脑应答率最高（41%），尽管这种方法成本高昂。诊所工作人员在患者离开诊所时发放纸质问卷的应答率最低（12%）。
可以通过多种调查方式引入CollaboRATE，同时产生一致的临床医生排名。这可能允许对临床医生和诊所的共同决策表现进行常规评估和基准测试。
