Stolz-Klingenberg Constanze, Bünzen Claudia, Coors Marie, Flüh Charlotte, Margraf Nils G, Wehkamp Kai, Clayman Marla L, Scheibler Fueloep, Wehking Felix, Rüffer Jens Ulrich, Schüttig Wiebke, Sundmacher Leonie, Synowitz Michael, Berg Daniela, Geiger Friedemann
National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein, Kiel, Germany.
Chair of Health Economics, Technical University of Munich, Munich, Germany.
Front Neurol. 2022 Nov 23;13:1037447. doi: 10.3389/fneur.2022.1037447. eCollection 2022.
SHARE TO CARE (S2C) is a comprehensive implementation program for shared decision making (SDM). It is run at the University Hospital Schleswig-Holstein (UKSH) in Kiel, Germany, and consists of four combined intervention modules addressing healthcare professionals and patients: (1) multimodal training of physicians (2) patient activation campaign including the ASK3 method, (3) online evidence-based patient decision aids (4) SDM support by nurses. This study examines the sustainability of the hospital wide SDM implementation by means of the Neuromedical Center comprising the Departments of Neurology and Neurosurgery.
Between 2018 and 2020, the S2C program was applied initially within the Neuromedical Center: We implemented the patient activation campaign, trained 89% of physicians ( = 56), developed 12 patient decision aids and educated two decision coaches. Physicians adjusted the patients' pathways to facilitate the use of decision aids. To maintain the initial implementation, the departments took care that new staff members received training and decision aids were updated. The patient activation campaign was continued. To determine the sustainability of the initial intervention, the SDM level after a maintenance phase of 6-18 months was compared to the baseline level before implementation. Therefore, in- and outpatients received a questionnaire mail after discharge. The primary endpoint was the "Patient Decision Making" subscale of the Perceived Involvement in Care Scale (PICS). Secondary endpoints were an additional scale measuring SDM (CollaboRATE), and the PrepDM scale, which determines patients' perceived health literacy while preparing for decision making. Mean scale scores were compared using -tests.
Patients reported a significantly increased SDM level (PICS = 0.02; Hedges' = 0.33; CollaboRATE = 0.05; Hedges' = 0.26) and improved preparation for decision making (PrepDM = 0.001; Hedges' = 0.34) 6-18 months after initial implementation of S2C.
The S2C program demonstrated its sustainability within the Neuromedical Center at UKSH Kiel in terms of increased SDM and health literacy. Maintaining the SDM implementation required a fraction of the initial intensity. The departments took on the responsibility for maintenance. Meanwhile, an additional health insurance-based reimbursement for S2C secures the continued application of the program.
SHARE TO CARE promises to be suitable for long-lasting implementation of SDM in hospitals.
“分享关爱”（S2C）是一项针对共同决策（SDM）的全面实施计划。该计划在德国基尔的石勒苏益格 - 荷尔斯泰因大学医院（UKSH）开展，由四个针对医护人员和患者的联合干预模块组成：（1）医生的多模式培训；（2）包括ASK3方法的患者激活活动；（3）基于证据的在线患者决策辅助工具；（4）护士提供的SDM支持。本研究通过包括神经内科和神经外科的神经医学中心，考察全院范围内SDM实施的可持续性。
2018年至2020年期间，S2C计划最初在神经医学中心实施：我们开展了患者激活活动，培训了89%的医生（共56名），开发了12种患者决策辅助工具，并培训了两名决策指导人员。医生调整了患者的就医流程，以方便使用决策辅助工具。为维持最初的实施效果，各科室确保新员工接受培训，决策辅助工具得到更新。患者激活活动继续开展。为确定最初干预措施的可持续性，将6 - 18个月维持阶段后的SDM水平与实施前的基线水平进行比较。因此，门诊和住院患者在出院后收到问卷调查邮件。主要终点是“感知参与护理量表”（PICS）中的“患者决策制定”子量表。次要终点是另一个衡量SDM的量表（CollaboRATE），以及PrepDM量表，该量表在患者准备决策时确定其感知健康素养。使用t检验比较平均量表得分。
在最初实施S2C后的6 - 18个月，患者报告SDM水平显著提高（PICS，P = 0.02；Hedges' g = 0.33；CollaboRATE，P = 0.05；Hedges' g = 0.26），决策准备情况有所改善（PrepDM，P = 0.001；Hedges' g = 0.34）。
S2C计划在基尔UKSH的神经医学中心展示了其在提高SDM和健康素养方面的可持续性。维持SDM的实施所需强度仅为初始强度的一部分。各科室承担了维持的责任。与此同时，基于医疗保险的S2C额外报销确保了该计划的持续应用。
“分享关爱”有望适用于医院中SDM的长期实施。
