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Effectiveness of DECIDE in patient-provider communication, therapeutic alliance, and care continuation
Investigator (PI): Alegria, Margarita
Performing Organization (PO): (Current): Massachusetts General Hospital, Department of Medicine, Disparities Research Unit / (617) 724-1237
(Past): Cambridge Health Alliance, Center for Multicultural Mental Health Research / (617) 503-8440
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2015
Final Year: 2018
Record Source/Award ID: PCORI/CD-12-11-4187-IC
Funding: Total Award Amount: $2,171,078
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Number of Subjects: 546
Abstract: Serious deficiencies in quality of behavioral health care have been identified, but experts suggest these deficiencies could be addressed if providers sought patients' perspectives 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: The objectives are to (1) test the effectiveness of DECIDE-PA+PC compared to usual care in improving SDM and patient-perceived quality of behavioral health care; (2) test whether patient-centered communication and therapeutic alliance mediate the effect of DECIDE-PA+PC on SDM; and (3) 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.
MeSH Terms:
  • Communication
  • Continuity of Patient Care
  • Decision Making
  • Ethnic Groups
  • Humans
  • Language
  • Mental Health Services /*organization & administration
  • Patient Participation
  • Patient Preference
  • * Professional-Patient Relations
  • Program Development
  • Program Evaluation
  • Quality of Health Care
  • Randomized Controlled Trials as Topic
Country: United States || United States
State: Massachusetts || Massachusetts
Zip Code: 02114 / 02143
UI: 20143191
CTgovId: NCT01947283
Project Status: Completed
Record History: ('2017: Project extended to 2018',) ('2018: PO changed',)