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Nolan Garcia
Nolan Garcia

16 : Decision



SDM can help integrate into care the findings from patient-centered outcomes research (PCOR) -- research that evaluates and compares the impact of two or more preventive, diagnostic, treatment, or healthcare delivery approaches on health outcomes. Integrating findings from PCOR into SDM helps patients and clinicians become more informed about the medical condition requiring action as well as the benefits and harms of each treatment option. As patients become more knowledgeable, they can be better equipped to have productive discussions with clinicians and to make informed, evidence-based health care decisions that are aligned with their personal values and preferences.




16 : Decision



Interest in and support for SDM has grown steadily over the last several decades and has increased exponentially in recent years. At the policy level, the Patient Protection and Affordable Care Act included provisions to increase SDM. The Centers for Medicare & Medicaid Services has included requirements related to SDM as part of some recent coverage with evidence development decisions. Most patients prefer to be actively involved in health care decision making, and evidence suggests that patient-reported SDM is positively associated with affective and cognitive outcomes such as improved patient satisfaction and reduced decisional conflict. SDM has the potential to improve behavioral and physical health outcomes, impact utilization rates, lower costs, and reduce unwarranted variations in care. However, the body of evidence, although extensive, has not found consistently favorable impact of SDM on these outcomes. Still, SDM has the potential to promote patient-centered care and thus improve health care quality. Many providers, practices, and health care systems have implemented interventions to promote and facilitate SDM.


Unfortunately, however, SDM has proven difficult to measure. Indeed, the literature points to several significant gaps and limitations in the measurement of SDM. First, of the many measures that have been developed, most focus on antecedents to SDM (patient preferences, decision making confidence, etc.) or decision outcomes (satisfaction, conflict, regret, etc.). Few measures focus on the process of SDM.


The measures should not be designed to only assess SDM in the context of any one specific decision. Instead, the measure should capture SDM across the different types of clinical decisions that may be made. Additionally, the measures should not be designed to assess the efficacy or impact of a specific decision aid. Although the measures may be used to assess SDM when a decision aid is used, the measures should be designed to capture SDM regardless of whether a decision aid is used.


Applications will be assigned on the basis of established AHRQ referral guidelines to the appropriate AHRQ Office or Center. Applications will compete for available funds with all other recommended applications submitted in response to this FOA. The following will be considered in making funding decisions:


Advance care planning includes completing an Advance Directive (also known as a living will) and appointing a Health Care Power of Attorney (someone to make healthcare decisions for you if you are unable to speak for yourself). Then, most importantly, sharing your decisions with your family and loved ones.


Welcome to the FAA Part 16 Rules and Administrative Decisions Database. The FAA issues final administrative decisions in cases involving complaints against Federally assisted airports. This site provides access to the FAA Part 16 rules of practice and administrative decisions.


Germany, the Netherlands, and the United Kingdom have well-established climate information systems, although each country's system is organized somewhat differently. In each, the government provides direction and funding, and entities within and outside the government provide technical assistance to help decision makers understand how to use climate information in planning.


Federal climate information efforts could be improved by incorporating key organizational and data elements, according to GAO reports, studies by the National Academies and other organizations, site visits to three countries with climate information systems, and interviews with stakeholders. Specifically, the key elements are (1) a focused and accountable organization, (2) authoritative data that define the best available information for decision makers, and (3) technical assistance to help decision makers access, translate, and use climate information in planning. Authoritative locally-focused information is crucial because it defines a common starting point for decision makers, and most decisions are made at the local level.


Options to provide climate information and technical assistance to decision makers have strengths and limitations, according to studies, international site visits, and interviews with stakeholders. For example, a new federal agency would have a focused mission but could face turf conflicts with existing programs at other agencies. On the other hand, a national climate information system could be developed that would incorporate the best features and address the limitations of these options. Similar to the programs in Germany, the Netherlands, and the United Kingdom, a national system to provide climate information to U.S. decision makers could have roles for federal and nonfederal entities. Based on GAO's review of systems in other countries, studies, and interviews with stakeholders, a key federal role in a national climate information system would be to provide authoritative data and quality assurance guidelines for how to use the data. A nonfederal entity would be better positioned to provide on-the-ground technical assistance and facilitate connections between decision makers and intermediaries with expertise.


Over the last decade, the federal government incurred over $300 billion in costs due to extreme weather and fire, according to the President's 2016 budget request. Costs are expected to grow as rare events become more common and intense due to climate change, according to the National Academies. State, local, and private sector decision makers also drive fiscal exposures, as they are responsible for infrastructure paid for with federal funds or eligible for disaster aid. GAO's 2015 High-Risk update prioritized improving federal efforts to provide the best available climate information and technical assistance to help decision makers use the information to build resilience in up front.


This report examines (1) the extent to which federal efforts meet the climate information needs of decision makers; (2) examples of how other countries organized climate information systems; (3) whether and how federal efforts could be improved; and (4) the strengths and limitations of different options to provide climate information. GAO analyzed reports; reviewed systems in three other countries; and interviewed stakeholders with knowledge of climate information.


The IFRS Interpretations Committee (Committee) discussed the following matter and tentatively decided not to add a standard-setting project to the work plan. The Committee will reconsider this tentative decision, including the reasons for not adding a standard-setting project, at a future meeting. The Committee invites comments on the tentative agenda decision. All comments will be on the public record and posted on our website unless a respondent requests confidentiality and we grant that request. We do not normally grant such requests unless they are supported by good reason, for example, commercial confidence.


The deadline for commenting on the tentative agenda decision is 6 February 2023. The Committee will consider all comments received in writing by that date; agenda papers analysing comments received will include analysis only of comments received by that date.


Objectives: To describe the grading of recommendations assessment, development and evaluation (GRADE) interactive evidence to decision (EtD) frameworks for tests and test strategies for clinical, public health, or coverage decisions.


Study design and setting: As part of the GRADE Working Group's DECIDE project, we conducted workshops, user testing with systematic review authors, guideline developers and other decision makers, and piloted versions of the EtD framework.


Results: EtD frameworks for tests share the structure, explicitness, and transparency of other EtD frameworks. They require specifying the purpose of the test, linked or related management, and the key outcomes of concern for different test results and subsequent management. The EtD criteria address test accuracy and assessments of the certainty of the additional evidence necessary for decision making. When there is no direct evidence of test effects on patient-important outcomes, formal or informal modeling is needed to estimate effects. We describe the EtD criteria based on examples developed with GRADEpro (www.gradepro.org), GRADE's software that also allows development and dissemination of interactive summary of findings tables.


Conclusion: EtD frameworks for developing recommendations and making decisions about tests lay out the sequential steps in reviewing and assessing the different types of evidence that need to be linked.


NHDD was founded in 2008 by Nathan Kottkamp, a Virginia-based health care lawyer, to provide clear, concise, and consistent information on healthcare decision-making to both the public and providers/facilities through the widespread availability and dissemination of simple, free, and uniform tools (not just forms) to guide the process.


NHDD is aseries of independent events held across the country, supported by a nationalmedia and public education campaign. In all respects, NHDD is inclusive andbrings a variety of players in the larger healthcare, legal, and religiouscommunity together to work on a common project, to the benefit of patients,families, and providers. A key goal of NHDD is to demystify healthcaredecision-making and make the topic of advance care planning inescapable. Amongother things, NHDD helps people understand that advance healthcare decision-makingincludes much more than living wills; it is a process that should focus firston conversation and choosing an agent. 041b061a72


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