| Measure Components | The CDU uses a standard process/protocol for implementing SDM in clinical settings for patients with HBP, including: |
| One of the following: | |
| • Structured decision aids | |
| - A formal SDM tool is available, with evidence that it is being routinely used in clinical encounters. | |
| ■ The choice of a decision aid should be informed by a formal quality assessment, as recommended by IPDAS.165 The tool should be published, free of bias, and ideally endorsed by professional organizations. | |
| - A process exists whereby patients with hypertension are identified and exposed to the SDM tool. | |
| ■ A formal SDM encounter occurs between the patient and provider using an evidence-based decision tool before initiation or adjustment of GDMT. | |
| • Communication skills training for providers | |
| - A program exists to provide skills in SDM to practitioners, with periodic assessments of providers’ skills. | |
| • Built-in triggers in EHRs to remind clinicians to provide a decision aid to patients with hypertension. | |
| - The use of an SDM tool is documented within the EHR. | |
| - A process exists for identifying patients with hypertension who have not participated in SDM so that such a process can be offered. | |
| Rationale | |
| Decisions about primary prevention should be collaborative between a clinician and a patient. SDM occurs when practitioners engage patients in discussions about personalized ASCVD risk estimates and their implications on the perceived benefits of preventive strategies, including lifestyle habits, goals, and medical therapies. Collaborative decisions are more likely to address potential barriers to treatment options.166–169 | |
| SDM is defined as “an approach where clinician and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences.”79,170 It draws on the principles of patient-centered care to increase patient commitment to treatment plans, including long-term adherence to drug therapy and lifestyle modification.168,171,172 | |
| Adherence to GDMT of hypertension can be enhanced by SDM between clinicians and patients. Patients should be engaged in the selection of antihypertensive drug therapy and lifestyle modification strategies, with consideration of individual values, preferences, and associated conditions and comorbidities (2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease14). | |
| Measuring SDM in clinical settings | |
| One of the following, supplemented with a process for systematic analysis and feedback to practitioners: | |
| • Patient-reported measures of SDM | |
| - The 3-item CollaboRATE Scale173 | |
| - The 9-item Shared Decision-Making Questionnaire (SDM-Q-9 Patient Version)174 | |
| - The 4-item SURE Scale175 | |
| • Provider-reported measures of SDM | |
| - The 9-item Shared Decision-Making Questionnaire (SDM-Q-Doc)176 | |
| Clinical Recommendations | |
| 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease14 | |
| Recommendations for Shared Decision Making (Section 2.1, 2019 Prevention Guideline) | |
| 1. Shared decision making should guide discussions regarding the best strategies to reduce ASCVD risk.166–169 (Class 1, Level of Evidence: B-R) | |
ACC indicates American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CDU, care delivery unit; EHR, electronic health record; GDMT, guideline-directed medical therapy/treatment; HBP, high blood pressure; IPDAS, International Patient Decision Aid Standards; and SDM, shared decision making.