Notes & Links: October 17, 2013

Some more thoughts on shared decision making
Aaron Carroll writing in The Incidental Economist followed up on his previous post on shared decision making here. Carroll reviews a JAMA Viewpoint on  Shared Decision Making (SDM). 

He concurs that SDM informs patients and is something that must has to be done. And he further agrees that SDM creates a more satisfied patient. Where plumbs the depths of rational questioning is SDM does not equal cheaper patients. I am not sure there is definitive evidence that SDM does equal cheaper patients but Health Affairs had this study in February of this year. 

In this article we examine the relationship between patient activation levels and billed care costs. In an analysis of 33,163 patients of Fairview Health Services, a large health care delivery system in Minnesota, we found that patients with the lowest activation levels had predicted average costs that were 8 percent higher in the base year and 21 percent higher in the first half of the next year than the costs of patients with the highest activation levels, both significant differences. What’s more, patient activation was a significant predictor of cost even after adjustment for a commonly used “risk score” specifically designed to predict future costs. As health care delivery systems move toward assuming greater accountability for costs and outcomes for defined patient populations, knowing patients’ ability and willingness to manage their health will be a relevant piece of information integral to health care providers’ ability to improve outcomes and lower costs.

Delaying Vaccinations
I have been following the comments from this post I did yesterday. Thought I would share one. This is how physicians flame.

Author: Sheldon Weisgrau Comment: Emily, vaccinations are among the most studied, well understood medical interventions (and along with sanitation, the most successful public health measures ever implemented.  Remember small pox and polio?  Neither do I.  That’s the point.) If you question vaccines, I wonder how you prescribe any medical interventions to your patients?


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