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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Family Centered Care.

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Strategy. Patient Shared Decision Making

Approach. Expand patient shared decision making to pediatricians to better serve children in a family centered manner.

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Overview. Under a shared decision making. (SDM)PROCESS, healthcare practitioners and patients work together to make joint decisions about a patient’s care, informed by the patient’s preferences and values. SDM requires that patients be educated about and understand the risks and benefits of their options; education is often through decision aids such as pamphlets, videos, and computerized tools. SDM is an important part of patient-centered care.[1]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of pediatric practices trained by Title V adopt and implement SDM tools and process as part of their standard of care. (Shows the spread and scale of the approach)
  • Number of children and families who participate in SDM discussion focus groups led by Title V regarding treatment options, goals, and preferences. (Indicates the reach and engagement of the population served)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of pediatric practices trained by Title V adopt and implement SDM tools and process as part of their standard of care. (Shows the spread and scale of the approach)
  • Percent of children and families who participate in SDM discussion focus groups led by Title V regarding treatment options, goals, and preferences. (Indicates the reach and engagement of the population served)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of pediatric practices that regularly assess and address barriers to effective SDM with children and families as a result of participating in Title V facilitated trainings. (Shows impact of the approach's implementation)
  • Number of pediatric professional education and training programs conducted by Title V that include SDM and family-centered care as core competencies that result in an increase in knowledge and skill. (Indicates the integration and sustainability of the approach in workforce development)

OUTCOME MEASURES:

  • Number of pediatric adverse events, complications, or unnecessary treatments avoided as a result of informed and shared decision making between children, families, and pediatricians at pediatric practices trained by Title V. (Shows the approach's impact on improving patient safety and reducing harm)
  • Number of healthcare dollars saved by Title V's efforts of aligning pediatric care with evidence-based guidelines and patient preferences through the use of SDM. (Indicates the approach's potential for reducing waste and increasing value in pediatric healthcare spending)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of pediatric practices that regularly assess and address health barriers to effective SDM with children and families as a result of participating in Title V facilitated trainings. (Shows the impact of the approach's implementation)
  • Percent of pediatric professional education and training programs conducted by Title V that include SDM and family-centered care as core competencies that result in an increase in knowledge and skill. (Indicates the integration and sustainability of the approach in workforce development)

OUTCOME MEASURES:

  • Percent of pediatric adverse events, complications, or unnecessary treatments avoided as a result of informed and shared decision making between children, families, and pediatricians at pediatric practices trained by Title V. (Shows the approach's impact on improving patient safety and reducing harm)
  • Percent of healthcare dollars saved by Title V's efforts of aligning pediatric care with evidence-based guidelines and patient preferences through the use of SDM. (Indicates the approach's potential for reducing waste and increasing value in pediatric healthcare spending)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Cochrane-Legare 2014 - Légaré F, Ratté S, Stacey D, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database of Systematic Reviews. 2014;(5):CD006732.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.