Case Study of Decision Quality Instrument (DQI) Use

Case 1: Patient experience surveys
The Consumer Assessment of Health Providers and Systems (CAHPS) instruments are one of the most prominent applications for the measurement of the quality of decision making process. Investigators at HDSC have been working with the CAHPS team to improve the questions relating to patients’ experiences around shared decision making. One of the key standards for a Patient Centered Medical Home (PCMH) is that shared decision making should be routine.  The new NCQA-approved survey instrument for Clinicians and Groups (CG-CAHPS) that will be used to certify practices as PCMH, now includes a series of questions designed to measure shared decision making.  The series builds on the four key elements of a good decision process: that the pros and cons of an intervention are discussed, that reasonable alternatives are presented for consideration, and that the patient is asked about his or her own treatment preference.

A challenge with measuring shared decision making in the CAHPS surveys is that we have found that these questions are only informative when they are asked about a specific decision.  When people are asked to summarize across several decisions over the last year or six months, their answers become meaningless. However, there are not many decisions that occur often enough in primary care to get reliable information from a typical CAHPS survey sample, which to date, has precluded the use of the decision specific knowledge and goals items from the decision quality instruments. The decision to take a prescription drug is common enough to meet the sample requirements. Thus, the CG-CAHPS PCMH shared decision module focuses on that decision.  The series is as follows: 

  1. In the last 12 months, did you and this provider talk about starting or stopping a prescription medicine?
  2. When you talked about starting or stopping a prescription medicine, how much did this provider talk about the reasons you might want to take the medicine?
  3. When you talked about starting or stopping a prescription medicine, how much did this provider talk about the reasons you might not want to take the medicine? 
  4. When you talked about starting or stopping the prescription medicine, did this provider ask you what you thought was best for you?

A potential concern about these questions is that respondents could be talking about more than one medication decision. Further testing is underway to see if questions will produce more meaningful data when  the series is edited to focus on only a single medication decision (e.g. medicine for high cholesterol or high blood pressure).

See a list of available Decision Quality Instruments and learn more about the DQI development process.

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