Thank you for viewing the LAAO Registry Monthly Case Scenario for October of 2022, where we will discuss shared decision-making, sequence number 14732. A 74-year-old male presents for their LAAO procedure. The history and physical examination notes that the LAAO procedure was discussed with the patient by the interventional cardiologist prior to entering the procedure room. The risks and benefits of the procedure were discussed and reviewed with the patient. At the end of the conversation, the patient verbalized understanding and agreed to the procedure with assigned consent. There was no additional documentation of a patient-physician conversation concerning the procedure or alternative treatment options in the medical record. How is sequence number 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. What has occurred in this example is informed consent and not an example of shared decision-making. The reasons that the documentation does not meet the NCD criteria. Number one, the documentation shows that the interventional cardiologist who was performing the procedure was the person who discussed the procedure with the patient. This does not meet the NCD guidelines that states an independent non-interventional physician conducts the interaction. Number two, an evidence-based decision-making tool was not documented. And number three, there was no shared decision-making interaction documented in the medical record. Informed consent is not synonymous with shared decision-making. Informed consent is a brief description of the planned procedure and 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 contribute to the medical decision-making process and agree on treatment decisions. This has 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 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 LAAO registry. Any of the following would enable coding yes for sequence 14.732. Documentation that a non-interventional provider conducted a shared decision-making interaction. A statement by the provider that an STM encounter occurred with a non-interventional provider is sufficient for coding sequence 14.732 as yes. The use of an STM tool by the non-interventional provider would also allow for the coding of sequence 14.732 as yes. And lastly, using a smart phrase within the facility's EHR system regarding a shared decision-making interaction with a non-interventional provider is sufficient for coding sequence 14.732 as in addition to easing the burden of documentation and data abstraction. Sequence 14.732 shared decision-making seeks to capture documentation in the medical record indicating an STM encounter occurred with a non-interventional provider or physician for the current procedure. This data element is being added to the LAAO data set for the version 1.4 upgrade. If shared decision-making occurred for an LAAO procedure, sequence 14.733 SDM tool used will allow the site to indicate if a tool was used to facilitate the conversation between the non-interventional provider and the patient on the current procedure. When yes is coded, please indicate the SDM tool name in sequence number 14.734. This is an example of what the SDM data elements will look like in the data collection tool. There have been no decision-making tools added to the drop-down at present, so when a tool is used, please select Other for the interim. When the tool used is not in the drop-down list, please contact ncdr at acc.org to request the selection to be added. Shared decision-making occurs when a health care provider and a patient work together to make a health care decision that is best for the patient. The optimal decision takes into account evidence-based information about available options, the provider's knowledge and experience, and the patient's values and preferences. Both health care professionals and patients benefit from using shared decision-making. Log in to cbquality.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 SDM. Thank you for viewing the LAAO Registries Case Scenario for October of 2022 on Shared Decision-Making for Version 1.4. We'll see you next month for the next installment in our HASPLED series.

shared decision-making

LAAO procedure

case scenario

informed consent

alternative treatment options