22 The MAP (Measure Accurately, Act Rapidly, Partner with Patients) protocol has demonstrated an improvement in BP control from 61.2% at baseline to 89.9%.29-Results over 6 months, Discussion in a population that was about 50% Medicaid and 50% Black, 26-Table 1 SDM actions include implementing BP self-monitoring, reducing pill burden and minimizing medication costs.26-abstract without additional staff or resources beyond study training, 29-Discussion SDM is well-suited to hypertension management because many pharmacologic and nonpharmacologic treatments are both practical and appropriate for patients. Each of these reasonable interventions has its own tradeoffs, including risks, health benefits and quality-of-life implications. These elements may be valued differently from patient to patient, resulting in a variety of individually suitable treatment choices. SDM has the potential to improve health equity by better engaging patients and integrating patient preferences into treatment plans.30-Shared Decision Making as a Potential Way to Improve Health Equity, Conclusions Growing evidence also shows that SDM may promote and advance health equity by better engaging patients in their health care. The decision-making process and treatment(s) selected are explicitly tailored to individual patients’ preferences and values. For instance, the MAP intervention had a medically underrepresented population based on demographics and health insurance status. Although the population was about 50% Black — a group with lower documented BP control rates compared to white people — the intervention saw similar BP improvements in both Black and white patients.29-Discussion Effective SDM incorporates three components that can improve hypertension control both independently and collectively. 1. Patient endorsement of a shared decision-making style. 2. Proactive communication with the clinician about abnormal or out-of-goal BP readings. 3. Clinician’s use of collaborative communication when setting treatment goals.31-Abstract, Discussion There are no specific guidelines or comprehensive strategies on how to incorporate SDM into daily clinical practice, but multiple factors contribute to SDM success. Clinician training in SDM is critical; however, medical schools and residency programs seldom offer skills training or education on SDM.25-Health Care Policies and Practices to Support SDM Implementation AHA has a consumer health care site with resources and recommendations for SDM. Clinicians and health systems may believe that SDM increases clinical time. SDM can be incorporated into clinical practice without additional time or resources beyond training in SDM-specific tools and processes.29-Discussion Additionally, clinicians who are trained in and practice SDM may be eligible for reduced malpractice insurance rates in some states.25-Health Care Policies and Practices to Support SDM Implementation Interactive decision aids that visually illustrate individual patient CVD risk with and without lifestyle modifications and other treatments can aid shared decision-making.27-Conclusion Decision aids can be implemented via the electronic health system.25-Health Care Policies and Practices to Support SDM Implementation The ACC highlights cardiovascular decision aids from the University of Colorado,25-Health Care Policies and Practices to Support SDM Implementation and the AHA recommends the ACC/AHA Pooled Cohort Equations to estimate 10-year ASCVD risk.1-8.1.2 The AHA also suggests using the SHARE approach from the Agency for Healthcare Research and Quality (AHRQ). The five-step process helps facilitate SDM.25-Figure 2, 32 At the system level, SDM must be part of value-based care. The Centers for Medicare and Medicaid Services (CMS) already mandates SDM for at least two cardiac procedures and recommends SDM for other procedures. Keep in mind, implementation of SDM requires change to familiar, wellintegrated care patterns that continue to favor volume over value.25-Health Care Policies and Practices to Support SDM Implementation, Table 2 SDM is most effective when specifically tailored and personalized for a specific patient’s clinical characteristics, literacy and numeracy levels and for patients who are or want to be more engaged with their care.25-Effect of SDM Across the Cardiovascular Spectrum
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