Clinical Scorecard: Shared Decision-Making Is Institution-Driven

At a Glance

Key Highlights

• Two-thirds of procedures documented SDM and use of decision aids.
• Institutional factors significantly influence SDM reporting.
• Median odds of documented SDM vary over 100-fold between institutions.
• Patient characteristics have modest impact on SDM documentation.
• Medicare patients do not show higher odds of documented SDM despite reimbursement requirements.

Guideline-Based Recommendations

Diagnosis

• Assess patient eligibility for percutaneous left atrial appendage occlusion.

Management

• Implement shared decision-making processes and utilize patient decision aids.

Monitoring & Follow-up

• Evaluate the quality of SDM documentation and patient understanding.

Risks

• Consider that SDM may sometimes serve more as compliance than true preference-sensitive deliberation.

Patient & Prescribing Data

Patients undergoing percutaneous left atrial appendage occlusion, particularly those at higher risk.

Higher-risk patients are more likely to have documented SDM, potentially reinforcing clinical recommendations.

Clinical Best Practices

• Invest in institutional practices to standardize SDM documentation.
• Establish clearer standards for evaluating SDM quality.
• Assess the effectiveness of decision aids in improving patient alignment with values.

References

• JAMA Network Open