Hello, my name is Crystal Hastings, and I am presenting on how implementing a shared decision-making process can lead to improved patient outcomes. At the end of this presentation, participants should understand what shared decision-making is, be able to find and identify tools to use in their own practice, and lastly, understand the importance a SDM approach has on patient outcomes. Options for patients that seek aortic valve replacement have improved with the development of transcatheter therapies. Today, providers can medically manage their patients, suggest surgical valve replacement, or a transcatheter option. Not only have treatment options improved, but patient accessibility to information is greater than ever. However, medical choices are now determined simply on patients' preference between minimally invasive or an open-heart procedure. Although patient preference should be one essential part of medical decision-making, it should not be the only factor. This improved access in medical information has brought a greater need for patients to understand each treatment option in order to help direct them to the most appropriate rather than the most desirable course in replacing the aortic valve. Implementing a shared decision-making process improves the patient's perception of risk. It helps navigate therapy options with consideration of preference and goals, and enhances the clinic clinician and patient relationship. But what is shared decision-making? This process occurs when a healthcare provider and patient work together to make healthcare decisions that are 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. Ensuring a back-and-forth dialogue is important, so important that the American College of Cardiology has added it to the TVT Registry data collection form. It's just as important as the KCCQ and 5-meter walk. At Eisenhower Health, we want to provide our patients with the best options and ensure optimal outcomes. In order to do so, our multidisciplinary structural heart team knew that implementing a shared decision-making process would be key. The team outlined essential elements of an SVM approach and the effectiveness it would have for patients, physicians, and the organization as a whole. The team referenced decision aids such as CardioSmart. We implemented a process where both the cardiothoracic surgeon and the interventional cardiologist would discuss evidence-based information regarding available options with the patient, and then take the patient's values and preferences into consideration. After much discussion, our team decided on the SHARE approach. The SHARE approach is a five-step process for shared decision-making that includes exploring and comparing the benefits, harms, and risks of each health care option through meaningful dialogue about what matters most to the patient. S stands for Seek the Patient's Participation. Help the patient explore and compare treatment options. Assess the patient's values and preferences. Reach a decision with the patient. Identify the patient's decision. Our providers indicate that this process has been done with the following documentation noted in electronic medical records. The patient's goals and wishes have been clearly stated, understood, and respected during formulation of this treatment plan. A shared decision-making toolkit was utilized along the care continuum for this patient. The SDM toolkit is comprised of educational material outlining treatment options for aortic stenosis or mitral regurgitation and encompasses multiple conversations with the multidisciplinary HEART team to properly reconcile patient wishes and the HEART team recommendations. But why is shared decision-making so important? Well, in many cases, there are several treatment options. Oftentimes, evidence-based assessments of treatment options don't identify one treatment that is clearly superior to another. Shared decision-making guided by the providers can help patients understand the benefits and harms of these options and clarify their own values and preferences. In turn, this improves the patient's experience of their care. Also, it improves the patient's adherence of treatment recommendations, and there is emerging evidence that it can improve health outcomes. Anecdotally, meaningful patient-provider discussion on treatment options would enhance patient satisfaction. However, this study illustrates quantitative results that a shared decision-making process improves patient and STS-TVT registry outcomes. After implementing this process, Eisenhower Health observed a decrease in mortality from 2.6% in Q2 of 2021 to 0.8% in Q3 of 2021. In Q4 of 2021, we continued to have zero-all cause mortality. Disabling bleeds had a slight increase in Q3 of 2021, but then trended down to zero in Q4 of 2021. Re-admission rates decreased from 7.9% in Q2 of 2021 to 6.3% in Q3 of 2021. Moreover, this metric continues to decrease to 3.2% for Q4 of 2021. The result of implementing a shared decision-making process improved patient-physician communication, thus bettering the patient experience by allowing them to clarify their values and preferences when choosing a treatment plan. Moreover, providers noticed improved patient outcomes, which led to higher satisfaction within their own practice. Lastly, re-admission rates are continuing to decrease, which translates into a reduction in healthcare costs and better overall health for the patient. We here at Eisenhower Health are satisfied with the results of implementing a shared decision-making process within our Structural Heart Team. SDM adheres to the idea of a whole-person healthcare. This process not only increased patient satisfaction and the accuracy of their risk perception, but it has also had a direct impact on pre- and post-transcatheter aortic valve replacement procedural outcomes that positively affect our registry data. Institutions can replicate this process for any cardiovascular procedure patients may undergo, resulting in better outcomes for all aspects of a cardiovascular service line.

shared decision-making

patient outcomes

aortic valve replacement

healthcare providers

patient values