Welcome to the STS-ACC TVT Registry July Case Scenario for Version 3. This month, we will cover Sequence 14732, Shared Decision Making. A 74-year-old male presents for their TAVR procedure. Their history and physical examination notes that the TAVR procedure was discussed and risk versus benefit of the procedure were reviewed. At the end of the conversation, the patient verbalized understanding, and after answering all questions, he agreed to proceed. How is Sequence 14732, Shared Decision Making, coded? Number one, no. Or number two, yes. Please take a few moments to review the documentation and the question prior to making a final decision. And the answer is number one, no. Informed consent is not synonymous with shared decision making. Informed consent is a brief description of the planned procedure or surgery with the explanation of risks and benefits. This is a process of obtaining the patient's permission to proceed. Shared decision making is a patient-centered conversation where the clinician and patient together map out the best course of action based on patient preferences as it relates to the clinical evidence. It is a process in which both the patient and the physician or non-physician practitioner, such as a PA, NP, or CNS, contribute to the medical decision making process and agree on treatment decisions. This is shown to increase the knowledge and satisfaction regarding care, define clearer goals for treatment, and to align health decisions with patient values. Please work with the providers at your facility to determine a process of documentation that will allow for the coding of shared decision making, as this cannot be left to the interpretation of the abstractor or the TVT registry. A statement by the provider that an SDM encounter occurred is sufficient for coding Sequence Number 14732, Shared Decision Making, as Yes. The use of a shared decision making tool would allow for the coding of this sequence as Yes. Using a SMART phrase with the facility's EHR system regarding shared decision making is also sufficient for coding Sequence Number 14732, Shared Decision Making, as Yes, in addition to easing the burden of documentation and data abstraction. Sequence Number 14732, Shared Decision Making, seeks to capture documentation in the medical record indicating an SDM encounter occurred for the current procedure. This data element is being added to the basic data set for all TVT procedures. If shared decision making occurred for the TVT procedure, Sequence Number 14733, Shared Decision Making Tool Use, will allow the site to indicate if a tool was used to facilitate the conversation between the clinician and the patient on the current procedure. When Yes is coded, please indicate the SDM tool name in Sequence Number 14734. If the tool use is not in the drop-down list, please contact ncdr at acc.org to request the selection to be added. Currently, the NCDR is unaware of any evidence-based tools used for TAVR, TMVR, TMV, small r, and or TTVP. So why are we capturing shared decision making? Well, it's in the 2020 ACC AHA Guideline for the Management of Patients with Valvular Heart Disease, and as shown here, is a Class 1 recommendation for the evaluation of surgical and interventional risk. Where can you find more information about shared decision making? Log in to cvquality.acc.org where the Quality Improvement for Institutions page provides access to clinical toolkits and resources for your facility. Select Shared Decision Making to access information and a video on shared decision making. Thank you for viewing the July 2021 STS-ACC TVT Registry Case Scenario. We'll see you next month.

Sequence 14732

Shared Decision Making

TAVR procedure

informed consent

collaborative conversation