Project Summary
Serious deficiencies in quality of behavioral health care have been identified, but experts suggest these deficiencies could be addressed if providers sought patients’ perspective about their illness and shared power and responsibility. Shared decision making (SDM), a form of patient-provider communication where both parties bring expertise to make treatment decisions, has the potential to improve quality of behavioral health care. However, prior work on jointly improving patient and provider SDM in behavioral health has been inconclusive. Furthermore, there has been limited information to help identify effective SDM interventions, and whether they impact quality of care, or the underlying mechanisms leading to improvements in SDM; and there have been no prior studies of whether racial/ethnic or linguistic concordance influences SDM. Our research team conducted a patient intervention (DECIDE-PA) that showed improvements in patient activation and self-management in behavioral health care. However, we found that some providers were unresponsive or reacted negatively to patients’ increased activation, which may have led some patients to drop out of care. In response, we propose to combine DECIDE-PA with a provider coaching intervention (DECIDE-PC) to increase providers’ receptivity to patient activation and improve SDM. We also respond to clinic administrators who request evidence of the interventions’ impact on improving quality of care to sustain the intervention.
Objectives:
- test the effectiveness of DECIDE-PA+PC compared to usual care in improving SDM and patient-perceived quality of behavioral health care;
- test whether patient-centered communication and therapeutic alliance mediate the effect of DECIDE-PA+PC on SDM; and
- explore whether ethnic/racial or language matching between patient and provider moderates the relationship between the effect of DECIDE-PA+PC on SDM and quality of behavioral health care.
Methods: For Objective 1, we implement a randomized controlled trial comparing DECIDE-PA+PC with usual care on SDM and perceived quality. We identify treatment effects that account for differences in individual mental health, provider, and clinic characteristics across the experimental groups. For Objective 2, we identify underlying mechanisms of the effect of the DECIDE-PA+PC intervention on SDM with careful consideration to mediation analysis and adjustment for the timing of the measures so that we can increase confidence in our causal claims. For Objective 3, we expand Objective 1 models to test whether DECIDE-PA+PC impacts SDM and perceived quality of care differentially by concordant/discordant patient-provider dyads.
^ Margarita Alegria, PhD, was affiliated with the Cambridge Health Alliance when this project was funded.
Margarita Alegría, Kiara Alvarez, Rachel Zack Ishikawa, Karissa DiMarzio, and Samantha McPeck. Removing Obstacles To Eliminating Racial And Ethnic Disparities In Behavioral Health Care. Health Aff. 2016 35: 991-999.
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