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Health Expect. 2018 Feb;21(1):82-89. doi: 10.1111/hex.12588. Epub 2017 Jul 5.

Using CollaboRATE, a brief patient-reported measure of shared decision making: Results from three clinical settings in the United States.

Author information

1
The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA.
2
Dartmouth-Hitchcock Patient and Family Advisory Council, Lebanon, NH, USA.
3
Dartmouth Master of Health Care Delivery Science Program, Hanover, NH, USA.
4
Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
5
Harvard Medical School, Boston, MA, USA.
6
Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, MA, USA.
7
Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.

Abstract

INTRODUCTION:

CollaboRATE is a brief patient survey focused on shared decision making. This paper aims to (i) provide insight on facilitators and challenges to implementing a real-time patient survey and (ii) evaluate CollaboRATE scores and response rates across multiple clinical settings with varied patient populations.

METHOD:

All adult patients at three United States primary care practices were eligible to complete CollaboRATE post-visit. To inform key learnings, we aggregated all mentions of unanticipated decisions, problems and administration errors from field notes and email communications. Mixed-effects logistic regression evaluated the impact of site, clinician, patient age and patient gender on the CollaboRATE score.

RESULTS:

While CollaboRATE score increased only slightly with increasing patient age (OR 1.018, 95% CI 1.014-1.021), female patient gender was associated with significantly higher CollaboRATE scores (OR 1.224, 95% CI 1.073-1.397). Clinician also predicts CollaboRATE score (random effect variance 0.146). Site-specific factors such as clinical workflow and checkout procedures play a key role in successful in-clinic implementation and are significantly related to CollaboRATE scores, with Site 3 scoring significantly higher than Site 1 (OR 1.759, 95% CI 1.216 to 2.545) or Site 2 (z=-2.71, 95% CI -1.114 to -0.178).

DISCUSSION:

This study demonstrates that CollaboRATE can be used in diverse primary care settings. A clinic's workflow plays a crucial role in implementation. Patient experience measurement risks becoming a burden to both patients and administrators. Episodic use of short measurement tools could reduce this burden.

KEYWORDS:

patient experience measure; shared decision-making; survey

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