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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.

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



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.


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.


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).


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.


patient experience measure; shared decision-making; survey

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