Routine patient-reported experience measurement of shared decision-making in the USA: a qualitative study of the current state according to frontrunners

OBJECTIVES: To identify and describe instances of routine patient-reported shared decision-making (SDM) measurement in the USA, and to explore barriers and facilitators of routine patient-reported SDM measurement for quality improvement. SETTING: Payer and provider healthcare organisations in the USA. PARTICIPANTS: Current or former adult employees of healthcare organisations with prior SDM activity and that may be conducting routine SDM measurement (n=21). OUTCOMES: Qualitative interview and survey data collected through snowball sampling recruitment strategy to inform barriers and facilitators of routine patient-reported SDM measurement. RESULTS: Three participating sites routinely measured SDM from patients’ perspectives, including one payer organisation and two provider organisations—with the largest measurement effort taking place in the payer organisation. Facilitators of SDM measurement included SDM as a core organisational value or strategic priority, trialability of SDM measurement programmes, flexibility in how measures can be administered and existing momentum from payer-mandated measurement programmes. Barriers included competing organisational priorities with regard to patient-reported measurement and lack of perceived comparative advantage of patient-reported SDM measurement. CONCLUSIONS: Payers have a unique opportunity to encourage emphasis on SDM within healthcare organisations, including routine patient-reported measurement of SDM; however, provider organisations are currently best placed to make effective use of this type of data.