Shared decision making and patient reported outcomes among adults with atherosclerotic cardiovascular disease, medical expenditure panel survey 2006-2015.

Okunrintemi V, Valero-Elizondo J, Stone NJ, Blankstein R, Blaha MJ, Gulati M, Virani SS, Zoghbi WA, Michos ED, Nasir K. Shared decision making and patient reported outcomes among adults with atherosclerotic cardiovascular disease, medical expenditure panel survey 2006-2015. American journal of preventive cardiology. 2021 Dec 1; 8:100281.

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Abstract:

IMPORTANCE: Shared decision-making (SDM), one of the pillars of patient centered care is strongly encouraged and has been incorporated into the management of atherosclerotic cardiovascular disease (ASCVD) but the expansion of its use has been limited. OBJECTIVE: To determine the association of SDM on patient-reported health status, measures of quality of care, healthcare resource utilization, and healthcare spending among US adults with ASCVD. METHOD: This is a retrospective cohort study in an ambulatory setting, utilizing the Medical Expenditure Panel Survey (MEPS) 2006-2015. Analysis completed in December 2020. Participants included were adults 18 years and over with a diagnosis of ASCVD. We used the average weighted response to self-administered questionnaire evaluating shared-decision-making process as the exposure variable in the regression model. Outcome measures included inpatient hospitalizations, Emergency Department (ED) visits, statin and aspirin use, self-perception of health, and healthcare expenditure. RESULTS: When compared with individuals reporting poor SDM, those with optimal SDM were more likely to report statin and aspirin use [statin use, Odds Ratio (OR) 1.26 (95% CI, 1.09-1.46)], [aspirin use, 1.25 (1.07-1.45)], more likely to have a positive perception of their health and healthcare related quality of life, and were less likely to visit the ED [OR for = 2 ED visits: 0.81 (0.67-0.99)]. There was no difference between groups in annual total or out of pocket healthcare expenditure. CONCLUSION: This study suggests that effective SDM is associated with better utilization of healthcare resources and patient reported health outcomes. We hope these results could provide useful evidence for expanding the use of SDM in patient-centered care among individuals with ASCVD.