PCORI implementation projects promote the use of findings from PCORI-funded studies. The initiative on Implementation of Effective Shared Decision Making Approaches in Practice Settings funds projects like this one to promote the use of shared decision making strategies tested in PCORI-funded studies or incorporating evidence from PCORI-funded research, to support patients in making informed decisions about their care.
This project is in progress.
What were the results from the original PCORI-funded research study?
Both medicine and lifestyle changes, such as eating better and exercising, can help prevent diabetes. But not all people respond to these prevention approaches the same way. In the original study, the research team analyzed data from the Diabetes Prevention Program. They found that both medicine and lifestyle changes worked better in preventing diabetes for people at high risk for diabetes than for people at low risk. The team developed a tool to predict a person’s risk for diabetes to help doctors and patients understand how well different prevention approaches might work for that person.
Why is this research finding important?
More than 84 million Americans are at risk for diabetes. Few are getting treatment to prevent it; many are not even aware they are at risk. When they understand a person’s diabetes risk, patients and clinicians such as doctors and nurse practitioners can work together to decide on prevention approaches in a shared decision making process. Shared decision making allows patients and clinicians to discuss approaches and make decisions that consider the patient’s needs and preferences.
What is the goal of this project?
The project team wants to use the risk prediction tool to help improve shared decision making for people at risk for type 2 diabetes.
What is the project team doing?
The project team is adding the new tool for identifying diabetes risk to an existing shared decision making approach. In the project, staff such as pharmacists and nurses working in primary care clinics meet with patients at risk for diabetes. With each patient, they discuss that patient’s diabetes risk. They also share information about how a medicine, called metformin, and lifestyle changes can help prevent diabetes and ask about the patient’s preferences and values. The staff member helps the patient choose whether to make lifestyle changes or take metformin. Then the staff member sends a message to the patient’s primary care clinician informing them about the patient’s choice.
The project team is working in two health systems to put this shared decision making approach into place. They are following up with clinics in both systems to see how the approach is working.
How is the team evaluating this project?
The project team is looking at how many people take part in shared decision making in the two health systems. The team is asking patients how much they felt included in the decision-making process. Using medical records and interviews with clinic staff and managers, the team is looking at whether clinics used the shared decision making process as it was designed. Finally, the team is looking at changes in patient health after making a shared decision.
How is the team involving patients and others in making sure the findings reach people who can use them?
Patients at risk for diabetes are part of the project team and are helping plan all parts of the project. The team is also working with the American Medical Association and American Diabetes Association.