Using CollaboRATE, a brief patient‐reported measure of shared decision making: Results from three clinical settings in the United States

• Published in: Health expectations : an international journal of public participation in health care and health policy Vol. 21; no. 1; pp. 82 - 89
• Main Authors: Forcino, Rachel C., Barr, Paul J., O'Malley, A. James, Arend, Roger, Castaldo, Molly G., Ozanne, Elissa M., Percac‐Lima, Sanja, Stults, Cheryl D., Tai‐Seale, Ming, Thompson, Rachel, Elwyn, Glyn
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-02-2018; John Wiley and Sons Inc
• Subjects: Age; Clinical decision making; Collaboration; Cooperative Behavior; Decision Making; Email; Family medicine; Gender; Group decision making; Humans; Measurement; Original Research Paper; Original Research Papers; patient experience measure; Patient Participation - statistics & numerical data; Patient Reported Outcome Measures; Patient satisfaction; Patient-Centered Care; Polls & surveys; Primary care; Primary Health Care; Quantitative analysis; Sex Factors; shared decision‐making; survey; Surveys and Questionnaires; United States; United States; United States > US; patient experience measure; survey; shared decision-making
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/hex.12588

Introduction
CollaboRATE is a brief patient survey focused on shared decision making. This paper aims to (i) provide insight on facilitators and challenges to implementing a real‐time patient survey and (ii) evaluate CollaboRATE scores and response rates across multiple clinical settings with varied patient populations.
Method
All adult patients at three United States primary care practices were eligible to complete CollaboRATE post‐visit. To inform key learnings, we aggregated all mentions of unanticipated decisions, problems and administration errors from field notes and email communications. Mixed‐effects logistic regression evaluated the impact of site, clinician, patient age and patient gender on the CollaboRATE score.
Results
While CollaboRATE score increased only slightly with increasing patient age (OR 1.018, 95% CI 1.014‐1.021), female patient gender was associated with significantly higher CollaboRATE scores (OR 1.224, 95% CI 1.073‐1.397). Clinician also predicts CollaboRATE score (random effect variance 0.146). Site‐specific factors such as clinical workflow and checkout procedures play a key role in successful in‐clinic implementation and are significantly related to CollaboRATE scores, with Site 3 scoring significantly higher than Site 1 (OR 1.759, 95% CI 1.216 to 2.545) or Site 2 (z=−2.71, 95% CI −1.114 to −0.178).
Discussion
This study demonstrates that CollaboRATE can be used in diverse primary care settings. A clinic's workflow plays a crucial role in implementation. Patient experience measurement risks becoming a burden to both patients and administrators. Episodic use of short measurement tools could reduce this burden.