Hazel Tapp, PhD
A Carolinas HealthCare System researcher was recently awarded $2.1 million from the Patient-Centered Outcomes Research Institute (PCORI) to study shared medical decision making between providers and patients.
Hazel Tapp, PhD, associate director of research in the department of family medicine, was awarded a three-year PCORI grant to study the dissemination of shared decision making, designed to improve how providers interact with patients and how patients manage their condition. Specifically, the study will evaluate a novel mechanism for implementing an evidence-based shared decision making "toolkit" for asthma care into primary care settings.
"We are thrilled to receive this funding, which can help us to more quickly enhance the quality of life for our patients," said Dr. Tapp. "Through shared decision making, providers have the opportunity to increase patient engagement, improve patients' understanding of their healthcare choices and, together, create medical treatment plans that increase patient adherence and that decrease costs. Despite its numerous benefits, shared decision making is used only sporadically in the United States."
Asthma affects nearly 25 million people nationwide, half of whom experience at least one asthma attack each year. These attacks lead to 1.7 million Emergency Department (ED) visits and 450,000 hospitalizations annually. Poor health outcomes related to asthma are in part the result of the challenges of implementing new care delivery models into clinical practice.
Dr. Tapp and her research team at Carolinas HealthCare System began studying shared decision making three years ago, when they tested the toolkit across six ambulatory care practices in Mecklenburg County. Initial results show marked improvements in patient adherence to medications and decreases in asthma exacerbations, ED visits and hospitalizations for asthma.
Of 241 shared decision making visits between June 2011 and December 2012, 87 percent involved a shared decision for patients' asthma treatment plans. Comparative data of ED visits, six months pre- and post-visit, show ED visits decreased from 14.4 to 9.1 percent (a 36 percent decline) and inpatient hospitalizations declined from 4 to 1.7 percent (a 58 percent decline). There also was a decrease in use of oral steroids for asthma attacks, from 27 to 20 percent.
With the PCORI grant, Dr. Tapp and her team will evaluate a dissemination process to spread an Asthma Shared Decision Making Toolkit to practices in a Medicaid network using a consortium of practice-based research networks (NCNC). The knowledge gained from the study and statewide partnerships formed will facilitate dissemination to nearly 300 practices.
"We are excited to continue our work with providers throughout the state and to develop a more patient-centered approach to care delivery that is efficient and effective," said James McDeavitt, MD, former chief academic officer at Carolinas HealthCare System. "Dr. Tapp's work reflects the type of research that is needed, as it is directly tied to outcomes and has the potential to improve the health of our population in the near term. There are few healthcare systems nationally with the scope and scale to compete in this arena."
Carolinas HealthCare System's study is one of only 51 projects, totaling more than $88.5 million, approved for funding by PCORI's Board of Governors in May 2013. More than 400 applications nationwide were submitted and evaluated for scientific merit, patient and stakeholder engagement, and methodological rigor.
PCORI is an independent, non-profit organization that funds research aimed at providing patients, caregivers and clinicians with evidence-based information to make better-informed healthcare decisions and more immediately improve the health of patients.