title: Incentivizing shared decision making in the USA--where are we now?
abstract: BACKGROUND
  The Affordable Care Act raised significant interest in the process of shared decision making, the role of patient decision aids, and incentivizing their utilization. However, it has not been clear how best to put incentives into practice, and how the implementation of shared decision making and the use of patient decision aids would be measured. Our goal was to review developments and proposals put forward.
  
  
  METHODS
  We performed a qualitative document analysis following a pragmatic search of Medline, Google, Google Scholar, Business Source Complete (Ebscohost), and LexisNexis from 2009-2013 using the following key words: "Patient Protection and Affordable Care Act", "Decision Making", "Affordable Care Act", "Shared Decision Making", "measurement", "incentives", and "payment."
  
  
  RESULTS
  We observed a lack of clarity about how to measure shared decision making, about how best to reward the use of patient decisions aids, and therefore how best to incentivize the process. Many documents clearly imply that providing and disseminating patient decision aids might be equivalent to shared decision making. However, there is little evidence that these tools, when used by patients in advance of clinical encounters, lead to significant change in patient-provider communication. The assessment of shared decision making for performance management remains challenging.
  
  
  CONCLUSIONS
  Efforts to incentivize shared decision making are at risk of being limited to the promotion of patient decision aids, passing over the opportunity to influence the communication processes between patients and providers.
authors.affiliation: The Dartmouth Center for Health Care Delivery Science, 37 Dewey Field Rd, Hanover, NH 03768, USA; The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centera, Lebanon, NH 03766, USA. Electronic address: durand.marieanne@gmail.com.
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: Durand
authors.affiliation: The Dartmouth Center for Health Care Delivery Science, 37 Dewey Field Rd, Hanover, NH 03768, USA; The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centera, Lebanon, NH 03766, USA. Electronic address: Paul.J.Barr@dartmouth.edu.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Barr
authors.affiliation: The Dartmouth Center for Health Care Delivery Science, 37 Dewey Field Rd, Hanover, NH 03768, USA; The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centera, Lebanon, NH 03766, USA. Electronic address: thom.walsh9@gmail.com.
authors.forename: Thom
authors.initials: T
authors.lastname: Walsh
authors.affiliation: The Dartmouth Center for Health Care Delivery Science, 37 Dewey Field Rd, Hanover, NH 03768, USA; The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centera, Lebanon, NH 03766, USA. Electronic address: glyn.elwyn@gmail.com.
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
mesh_terms: D003142:Communication; D003657:Decision Making; D003658:Decision Making, Computer-Assisted; D003659:Decision Making, Organizational; D003661:Decision Support Techniques; D006801:Humans; D010358:Patient Participation; D058991:Patient Protection and Affordable Care Act; D010817:Physician-Patient Relations; D014481:United States
keywords: Incentives; Measurement; Pay for performance; Payment innovation; Shared decision making; The Affordable Care Act