Discussion and Shared Decision Making Surrounding Treatment Options
Percentage of patients aged 18 years and older with a diagnosis of hepatitis C with whom a physician or other qualified healthcare professional reviewed the range of treatment options appropriate to their genotype and demonstrated a shared decision making approach with the patient. To meet the measure, there must be documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment.
ACP does not support QPP measure 390: "Hepatitis C: Discussion of Shared Decision-Making Surrounding Treatment Options." While we support its efforts to encourage shared decisionmaking, this measure ceases to be relevant in an era of superior pharmacologic treatment advancements. Newer treatments have minimal side effects and therefore, decisions about tolerability are no longer applicable. Furthermore, measure developers do not cite any evidence to form the basis of the measure and do not include measurement validity or reliability data in the measure report. Additionally, the numerator specifications are unclear. Developers should consider revising the specifications to define explicit “shared decisionmaking” documentation requirements. Lastly, patients who receive government funded insurance may encounter accessibility barriers to treatment options. It may inappropriate to base treatment options on shared- decision making alone because payers play a significant role in the therapy selection process.