title: Shared Decision Making Guidance Reminders in Practice (SDM-GRIP).
abstract: OBJECTIVE
  Develop a system of practice tools and procedures to prompt shared decision making in primary care. SDM-GRIP (Shared Decision Making Guidance Reminders in Practice) was developed for suspected stable coronary artery disease (CAD), prior to the percutaneous coronary intervention (PCI) decision.
  
  
  METHODS
  Program evaluation of SDM-GRIP components: Grand Rounds, provider training (communication skills and clinical evidence), decision aid (DA), patient group visit, encounter decision guide (EDG), SDM provider visit.
  
  
  RESULTS
  Participation-Physician training=73% (21/29); patient group visits=25% of patients with diagnosis of CAD contacted (43/168). SDM visits=16% (27/168). Among SDM visit pairs, 82% of responding providers reported using the EDG in SDM encounters. Patients valued the SDM-GRIP program, and wanted to discuss comparative effectiveness information with a cardiologist. SDM visits were routinely reimbursed.
  
  
  CONCLUSIONS
  Program elements were well received and logistically feasible. However, recruitment to an extra educational group visit was low. Future implementation will move SDM-GRIP to the point of routine ordering of non-emergent stress tests to retain pre-decision timing of PCI and to improve coordination of care, with SDM tools available across primary care and cardiology.
  
  
  CONCLUSIONS
  Guidance prompts and provider training appear feasible. Implementation at stress testing requires further investigation.
authors.affiliation: Center for Ethics and Humanities in the Life Sciences, C203 East Fee, Michigan State University College of Human Medicine, East Lansing, MI 48824-1316, USA. mholmes@msu.edu
authors.forename: Margaret
authors.initials: M
authors.lastname: Holmes-Rovner
authors.forename: Karen
authors.initials: K
authors.lastname: Kelly-Blake
authors.forename: Francesca
authors.initials: F
authors.lastname: Dwamena
authors.forename: Katherine
authors.initials: K
authors.lastname: Dontje
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Henry
authors.forename: Adesuwa
authors.initials: A
authors.lastname: Olomu
authors.forename: David R
authors.initials: DR
authors.lastname: Rovner
authors.forename: Marilyn L
authors.initials: ML
authors.lastname: Rothert
mesh_terms: D003142:Communication; D003327:Coronary Disease / Q000628:therapy*; D003657:Decision Making; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D006801:Humans; D007318:Inservice Training; D010358:Patient Participation; D010817:Physician-Patient Relations; D011320:Primary Health Care; D015397:Program Evaluation; D011795:Surveys and Questionnaires