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The value of shared clinician-patient decision-making in the ED


“There is tremendous potential for driving value-based care in the emergency department through shared decision-making,” wrote Edward Melnick, M.D., assistant professor of emergency medicine at the Yale School of Medicine, and Erik Hess, M.D., associate professor of emergency medicine and research chair for the Department of Emergency Medicine at the Mayo Clinic, in a Health Affairs blog post: “As we continue to build incentives for value-based care into our healthcare system, we should not leave the ED out.”

The post reported on the value of decision-aids to encourage shared decision-making during a randomized control trial at six EDs across the U.S.  The pilot program used a decision aid, “Chest Pain Choice,” developed by Dr. Hess and his research team. Chest pain, a frequent cause of patient visits to the ER, often leads to unnecessary admissions. So Dr. Hess’s team wanted to know what would happen if clinicians took the time to inform patients of their options.

The results, they write, were increased patient engagement and a reduced number of  what turned out to be unnecessary hospital admissions for cardiac testing. Doctors Hess and Melnick see this as a “multibillion-dollar opportunity” to reduce waste in the healthcare system. The findings were so promising that the researchers are developing decision aids to discuss CAT scans for people with minor head trauma.

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