Association of shared decision-making on patient-reported health outcomes and healthcare utilization

Abstract

Background: Shared decision-making (SDM) is a process that respects the rights of patients to be fully involved in decisions about their care. By evaluating all available healthcare options and weighing patients' personal values and preferences against available unbiased evidence, patients and healthcare professionals can make health-related decisions together, as partners. We sought to evaluate the impact of perceived SDM on patient-reported outcomes, healthcare quality, and healthcare utilization.

Methods: Patients were identified from the 2010-2014 Medical Expenditure Panel Survey (MEPS) cohort. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey was levied to create a weighted composite score of satisfaction with SDM on a 12-point scale, and then categorized as optimal, average or poor SDM based on weighted scores. Weighting and variance techniques were applied to assure results were representative of the U.S. civilian population. Chi-square analysis was used to estimate differences across SDM groupings and multivariate logistic regression was performed to generate odds ratios (OR) and confidence intervals (CI).

Results: The study cohort included 63,931 responses to the survey tool. Results of SDM satisfaction across the three categories were skewed, with 46.6% (n = 29,807) of the respondents reporting optimal SDM, 42.1% (n = 26,887) reporting average scores and only 11.3% (n = 7237) reporting poor perceived SDM. Non-white race, lower educational level, low socioeconomic status, non-married status, and uninsured or underinsured status were all associated with higher incidence of poor perceived SDM (p < .05). Poor SDM was associated with increased odds of poor physical health scores (OR: 1.17; 95% CI 1.01-1.36) and poor mental health scores (OR: 1.53; 95% CI 1.25-1.86). Poor SDM was associated with lower use of statins (OR: 0.77; 95% CI 0.68-0.87) and aspirin (OR: 0.86; 95% CI 0.77-0.95), both of which are established quality of care metrics. Poor SDM was also associated with increased emergency department (ED) utilization, with an increased likelihood of 2 or more ED visits associated with poor SDM (OR: 1.25; 95% CI 1.06-1.49).

Conclusions: Poor SDM was associated with worse patient-reported health outcomes, worse established quality indicators, and higher healthcare utilization. While increasing physician education may help optimize SDM, differences in patient-perceived SDM were also strongly driven by inherent patient characteristics.

Keywords: Healthcare outcomes; Hospital utilization; Quality of care; Shared decision-making.