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Torbay Charts July 20
3
7
Torbay Charts
Patient Decision Aid
Raju Ramesh
6
Prepared on 14/07/2020
1
5
2
3
4
Thanks to
Dr Matt Halkes
HCI Team
S D M
Process in which patients:
- review all the treatment options available and
- actively participate with their healthcare professional in reaching that decision.
S D M
No decision about me, without me
Two experts
I C E
Dialogue
P D A
Concerns....
Inconvenience.....
Time-off...
Child care....
Risks....
Success...
Alternatives...
What if?.....
Success...
Risks...
I can fix you....
In my hands...
Evidence....
Alternatives....
P D A
What matters to the patients matters...
1) Empowers patients
2) Respect autonomy
1) Present appropriate choices
2) Allow true deliberation
3) Improves knowledge
4) Feel included
5) Ownership of decisions
- Improves compliance
- Less regret
- Less complaint
- Less litigation
P D A
6) Choose less invasive options (less expensive)
JBJS Am; 2017
11.4 % to 15.4% lower
Knee Arthritis
Short vs Long
JBJS (Am) 2019
What?
Is there a need for a new one?
Decision aids should be more than an information giving tool......
Present information in a way that is easy for people facing the decision to understand....
1) Impractical to use during consultation
2 ) Not comprehensive
3) Lack of relevance
4) Not layered
Why new?
Negatives
5) Visually unattractive
6) Different learning styles
7) Mostly paper based and "fixed"
8) No self-directed comparison
9) Expensive
10) Not locally developed
Two important things
Associations
Consent Law
Key issues
Choices
Materiality
The Nuts and Bolts
How TC works?
Torbay Charts
USP of
TC
1
Multilayered
Multiformat
Visually appealing
TC
2
Map for the Journey
USP of Torbay Charts
https://vimeopro.com/healthandcarevideos/pda/video/342202455
3
Overview
1
Diagnosis & Stage
All treatments displayed
2
Overview
3
A
B
Relevant
Relevant
Compare side by side
Similar to comparison website
Compare
Progress
of Torbay Charts so far......
Presentations
Progress so far...
Scaling up
3
Pilot
1
Presentations
2017
SDM meeting in Exeter
CCG / Expert patients / SWAHSN - QUIPPS panel
Covidized!
Devon STP clinical cabinet
Regional SDM collaboration - Taunton
Bristol / Kernow
International
Sweden - Microsystem Conference, 2019
Canada - 10th International SDM conference, 2019
Prof A O'Connor, Prof D Stacey, Prof A Coulter
2
Repository
Scaling up
Spread
Shoulder
Impingement
Arthritis
Frozen shoulder
Chronic Low Back Pain
Elbow tendinitis
BP
Cholesterol
STP
Barnstaple
Exeter
Derriford
St Austell
Bristol and South Gloucester CCG
NHS England Bid
Pilot test result
Plymouth (36)
Nt Devon Hospital (14)
Torbay Hospital (107)
Options
1) 78.6%
2) 78.6%
1) 93.5%
2) 93.5%
1) 86.1%
2) 88.9%
Support SDM
Post Covid use of Torbay Charts
7.4%
modest 2% surgery avoidance
Waiting list validation
- Reappraisal
- Redirection
£26 million/year savings
(based on NJR, 2018)
COVID-19 Torbay Charts
4
This is not the final version
COVID TC
Is there a need for a COVID-19 decision aid?
https://www.bbc.co.uk/news/video_and_audio/headlines/52752274/what-s-it-like-using-the-covid-19-contact-tracing-app
Colleague - family member
Colleague - son
COVID-19 Torbay Charts
4
This is not the final version
COVID TC
Single point of access
Logical navigation
Process information better
Confidence
- Self-care
- Seeking help
GP - remote guidance
NHS 111
www.torbaycharts.co.uk
Progress so far
- Presented to clinical management group (made of GP champions and hospital consultants, and Healthcare Professionals)
Help
- Very good feedback
5
- Presented to QUIPPS expert panel
- Excellent feedback from all 12 patient experts
Develop further
Raise awareness
Help
Spread wide
HCI Partnership
NHSX