Table 2.

Measuring patient values and preferences, SDM, and practice complexity

SCREENING ISSUETOOL OR PERFORMANCE MEASUREMENTMEASUREMENT CHALLENGES
Patient values and preferencesRely on subjective assessments of individual physicians and other health care providers in your practice and patient values and preferences obtained during patient encounters
  • Lack of validated instruments. Research on instruments is in the early stage of development43,44

SDMWhat do you seek to measure?
  • Electronic medical records not yet designed to support SDM

  • Wide variation in the quality of patient decision aids. Seek decision aids that provide estimates of harms and benefits with use of natural frequencies or absolute risk

Practice complexity*Consider the following:
  • basic demographic measures that include age, sex, and comorbidity of patients in individual practices

  • registries of patients who would be eligible for screening tests

  • flexible targets based on the demographic and social characteristics of the practice setting

  • the role of multidisciplinary team members in practice

  • Lack of risk-adjustment tools, instruments, or processes to measure complexity in the primary care setting23,46

  • Multiple preventive screening tests for the same patient

  • Screening in patients with comorbidity (eg, diabetes)

  • Screening in disadvantaged populations

  • Individual patient goals, priorities, and needs influence uptake of screening interventions (eg, not all patients will accept recommendations regardless of the strength of the recommendation)

  • Individual patient risk factors, circumstances, and priorities influence the time frame for uptake of screening interventions

  • SDM—shared decision making, SDM-Q-9—Shared Decision Making Questionnaire.

  • * Practice complexity is a dynamic and constantly emerging set of processes and objects that not only interact with each other, but come to be defined by those interactions.53