Union Leader - Sen. Shaheen Hears Success Of Patient-Centered Treatment

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Union Leader - Sen. Shaheen Hears Success Of Patient-Centered Treatment

By KRISTEN SENZ
Union Leader Correspondent

It might not be an easy pill for some doctors to swallow, but letting patients decide their own treatment should be the new doctrine for health care in America, staff at Dartmouth-Hitchcock Medical Center told Sen. Jeanne Shaheen yesterday.

Noah Hano, a real estate broker from Hamilton, Mass., needed to do something about the excruciating back pain that was controlling his life. A former tri-athlete who'd stopped training because of the pain, Hano called Dr. James Weinstein, a spine specialist at DHMC, in search of some answers.

Instead, what Hano got was information -- lots of it -- and guidance in making his own decision about whether to go under the knife. After learning about his options, Hano decided against surgery and, with physical therapy and other treatments, has significantly reduced his pain level.

DHMC was the first institution in the country to put this patient-centered model into practice with the creation 12 years ago of its Center for Shared Decision Making, which uses the hospital's spine center as a laboratory to test its success.

Comparative effectiveness research studies show it's working, according to Weinstein, who also serves as director of the Institute for Health Policy and Clinical Practice at DHMC. Most patients are satisfied with the outcomes, and because they tend to choose the least invasive option available, the process has also resulted in significant reductions in health care spending, Weinstein said.

"If we think about Noah, we'll get to the right place," he said. "We're sort of at this tipping point now, and something has to change, and it seems only natural to me that patients are involved in that change."

Using online statistics that show patients the effectiveness of various treatment options and videos that guide them through the decision-making process, the Center for Shared Decision Making promotes a shift from "the doctrine of informed consent to the doctrine of informed choice," said Weinstein, who led Shaheen and Sen. Amy Klobuchar, D-Minn., on a tour of the spine center at DHMC yesterday.

During a forum after the tour, Sen. Klobuchar, who is vacationing in New Hampshire with her family, said Dartmouth's comparative effectiveness research has informed the debate over health care reform in Washington.

"I don't think I've given a speech about health care on the Senate floor without using the word, 'Dartmouth,'" she said, "because of the cutting-edge research going on here."

For physicians in private practice, however, implementing these changes comes with challenges not faced by doctors at DHMC, who work within integrated group practices.

"Incorporating this kind of work into clinical practice can be threatening," Weinstein said. "It can be threatening to your autonomy as a practitioner and it can be threatening to your income." But giving patients all the information available about their conditions and their alternatives for treatment is "the right thing to do," Weinstein said, and it also saves taxpayer dollars.

Shaheen said she's intrigued by study results that show more health care spending doesn't necessarily mean better health.

"Just because you spend more money doesn't mean you improve your treatment," she said. "And that will help to address some of the other real concerns we have with the system."

The American Recovery and Reinvestment Act included $1.1 billion for institutions across the country to conduct further comparative effectiveness research.

Weinstein said DHMC is now working to help health care providers in 38 states plan for and implement patient-centered health care models.

Shaheen said she's working to pass legislation that would reward and provide incentives to health care practitioners who provide high quality care and implement patient-centered models.

"The way it works right now, (because of the way health care reimbursements are structured), some states, like Minnesota and New Hampshire, are actually punished for doing this," she said.

Meanwhile, Weinstein is working with new Dartmouth College President Dr. Jim Yong Kim to create an undergraduate program in health policy and clinical practice.

Weinstein said he's hopeful that through these local and national efforts, the American health care system can become one that provides higher quality care and better outcomes at a lower cost.

"I think when you are in a crisis, you start looking for unique opportunity," he said.

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