@Article{info:doi/10.2196/32666,
author="Sperl-Hillen, JoAnn M
and Anderson, Jeffrey P
and Margolis, Karen L
and Rossom, Rebecca C
and Kopski, Kristen M
and Averbeck, Beth M
and Rosner, Jeanine A
and Ekstrom, Heidi L
and Dehmer, Steven P
and O'Connor, Patrick J",
title="Bolstering the Business Case for Adoption of Shared Decision-Making Systems in Primary Care: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="6",
volume="6",
number="10",
pages="e32666",
keywords="clinical decision support; primary care; ICD-10 diagnostic coding; CPT levels of service; shared decision-making",
abstract="Background: Limited budgets may often constrain the ability of health care delivery systems to adopt shared decision-making (SDM) systems designed to improve clinical encounters with patients and quality of care. Objective: This study aimed to assess the impact of an SDM system shown to improve diabetes and cardiovascular patient outcomes on factors affecting revenue generation in primary care clinics. Methods: As part of a large multisite clinic randomized controlled trial (RCT), we explored the differences in 1 care system between clinics randomized to use an SDM intervention (n=8) versus control clinics (n=9) regarding the (1) likelihood of diagnostic coding for cardiometabolic conditions using the 10th Revision of the International Classification of Diseases (ICD-10) and (2) current procedural terminology (CPT) billing codes. Results: At all 24,138 encounters with care gaps targeted by the SDM system, the proportion assigned high-complexity CPT codes for level of service 5 was significantly higher at the intervention clinics (6.1{\%}) compared to that in the control clinics (2.9{\%}), with P<.001 and adjusted odds ratio (OR) 1.64 (95{\%} CI 1.02-2.61). This was consistently observed across the following specific care gaps: diabetes with glycated hemoglobin A1c (HbA1c)>8{\%} (n=8463), 7.2{\%} vs 3.4{\%}, P<.001, and adjusted OR 1.93 (95{\%} CI 1.01-3.67); blood pressure above goal (n=8515), 6.5{\%} vs 3.7{\%}, P<.001, and adjusted OR 1.42 (95{\%} CI 0.72-2.79); suboptimal statin management (n=17,765), 5.8{\%} vs 3{\%}, P<.001, and adjusted OR 1.41 (95{\%} CI 0.76-2.61); tobacco dependency (n=7449), 7.5{\%} vs. 3.4{\%}, P<.001, and adjusted OR 2.14 (95{\%} CI 1.31-3.51); BMI >30 kg/m2 (n=19,838), 6.2{\%} vs 2.9{\%}, P<.001, and adjusted OR 1.45 (95{\%} CI 0.75-2.8). Compared to control clinics, intervention clinics assigned ICD-10 diagnosis codes more often for observed cardiometabolic conditions with care gaps, although the difference did not reach statistical significance. Conclusions: In this randomized study, use of a clinically effective SDM system at encounters with care gaps significantly increased the proportion of encounters assigned high-complexity (level 5) CPT codes, and it was associated with a nonsignificant increase in assigning ICD-10 codes for observed cardiometabolic conditions. Trial Registration: ClinicalTrials.gov NCT 02451670; https://clinicaltrials.gov/ct2/show/NCT 02451670 ",
issn="2561-326X",
doi="10.2196/32666",
url="https://formative.jmir.org/2022/10/e32666",
url="https://doi.org/10.2196/32666",
url="http://www.ncbi.nlm.nih.gov/pubmed/36201392"
}