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제도적 관점에서 본 공유의사결정에 대한 탐색적 고찰: 주요 국가의 선행 경험이 한국에 주는 시사점을 중심으로

Exploratory Reflections on Shared Decision-making from an Institutional Perspective: Lessons and Implications for Korea based on the Prior Experiences of Various Countries

유상호|이도영|우경숙|윤현옥
대한의료커뮤니케이션학회 (Korean Academy on Communication in Healthcare)|2024.12|의료커뮤니케이션 (Health Communication, the Official Journal of Korean Academy on Communication in Healthcare)|제19권 제2호|pp. 7-18|DOI 10.15715/kjhcom.2024.19.2.7

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참고문헌

키워드

환자참여Health policy환자중심의료공유의사결정Patient participation보건정책Patient-centered healthcareShared decision making
주제분류의학일반

초록

Purpose : As the healthcare paradigm shifts towards a patient-centered approach, shared decision-making (SDM) is gaining importance. SDM involves selecting treatment options through expert information provided by healthcare professionals and active patient engagement. This study examines international cases of SDM implementation to derive insights for establishing a system suitable for the domestic healthcare environment. Methods : We selected four countries-the United States, the United Kingdom, Germany, and the Netherlands-that have adopted SDM as a key element of patient-centered care. These countries are conducting government-led pilot programs or integrating SDM into healthcare coverage through insurance benefits. Our analysis is based on a review of laws, policy reports, research publications, and academic literature. Results : The United States, through the Centers for Medicare & Medicaid Services (CMS), has piloted SDM in Medicare and hospices and is expanding policies to include SDM within insurance coverage for certain hospital departments. The United Kingdom’s National Health Service (NHS) incorporates SDM into chronic disease management programs, with plans to extend it to primary and community care. Germany has successfully piloted various SDM models and educational programs and is integrating SDM into routine care. In the Netherlands, the government is actively funding a range of SDM-related projects, from the development of SDM tools to performance evaluations, playing a crucial role in promoting SDM in hospitals. Conclusion : Key factors for the successful adoption of SDM include strong government support, stakeholder collaboration, a robust legal framework, standardized guidelines, and appropriate payment systems for healthcare providers.

Abstract

Purpose : As the healthcare paradigm shifts towards a patient-centered approach, shared decision-making (SDM) is gaining importance. SDM involves selecting treatment options through expert information provided by healthcare professionals and active patient engagement. This study examines international cases of SDM implementation to derive insights for establishing a system suitable for the domestic healthcare environment. Methods : We selected four countries-the United States, the United Kingdom, Germany, and the Netherlands-that have adopted SDM as a key element of patient-centered care. These countries are conducting government-led pilot programs or integrating SDM into healthcare coverage through insurance benefits. Our analysis is based on a review of laws, policy reports, research publications, and academic literature. Results : The United States, through the Centers for Medicare & Medicaid Services (CMS), has piloted SDM in Medicare and hospices and is expanding policies to include SDM within insurance coverage for certain hospital departments. The United Kingdom’s National Health Service (NHS) incorporates SDM into chronic disease management programs, with plans to extend it to primary and community care. Germany has successfully piloted various SDM models and educational programs and is integrating SDM into routine care. In the Netherlands, the government is actively funding a range of SDM-related projects, from the development of SDM tools to performance evaluations, playing a crucial role in promoting SDM in hospitals. Conclusion : Key factors for the successful adoption of SDM include strong government support, stakeholder collaboration, a robust legal framework, standardized guidelines, and appropriate payment systems for healthcare providers.

참고문헌 (50)

  1. Bauman AE, "Getting it right : why bother with patient-centred care?", Medical Journal of Australia, 179(5), pp.253~256 (2003)
  2. Elwyn G, "Shared decision making : What is the work?", Patient Education and Counseling, 104(7), pp.1591~1595 (2021)
  3. Shay LA, "Where is the evidence? A systematic review of shared decision making and patient outcomes", Medical Decision Making, 35(1), pp.114~131 (2015)
  4. Tang C, "Exploring motivations and resistances for implementing shared decision-making in clinical practice : A systematic review based on a structure–process–outcome model", Health Expectations, 25(4), pp.1254~1268 (2022)
  5. Bae H, "Medical Liability in Asia and Australasia", pp.267~282 (2022)
  6. Yoon S-C, "Compensation and exemption for damage caused by loss of treatment chance", The Journal of Property Law, 40(3), pp.131~155 (2023)
  7. Ryoo S, "Elder Voices in Oncology : Awareness of Cancer Treatment Choices and Conflicts in Decision Making", Korean Journal of Geriatrics &Gerontology, 25(1), pp.39~48 (2024)
  8. Kwon KE, "A Study on the Model of life-sustaining treatment Decision Making through Shared Decision Making at the end of life", Journal of the Korea Bioethics Association, 20(1), pp.45~61 (2019)
  9. Kim S, "An exploratory study on the shared decision-making as a two-way symmetrical communication process : focusing on the communication of kidney dialysis patients", Korean Journal of Journalism &Communication Studies, 65(2), pp.162~204 (2021)
  10. Health Insurance Coverage in the United States: 2022, "Keisler-Starkey K", US Census Bureau, 9~, pp.report P60-281 (2023)
  11. "What are the value-based programs? : CMS"[URL]
  12. Sabatino CP, "The evolution of health care advance planning law and policy", The Milbank Quarterly, 88(2), pp.211~239 (2010)
  13. Childress JF, "What Does the Evolution From Informed Consent to Shared Decision Making Teach Us About Authority in Health Care?", AMA journal of ethics, 22(5), pp.E423~ (2020)
  14. La Puma J, "Advance directives on admission clinical implications and analysis of the Patient Self-Determination Act of 1990", JAMA, 266(3), pp.402~405 (1991)
  15. Alston C, "Shared decision-making strategies for best care : patient decision aids", NAM Perspectives (2014)
  16. "Beneficiary engagement and incentives models: shared decision making mode: CMS"[URL]
  17. Harrison KL, "First medicare demonstration of concurrent provision of curative and hospice services for end-of-life care", American Journal of Public Health, 106(8), pp.1405~ (2016)
  18. Matlock DD, "Enhancing success of medicare’s shared decision making mandates using implementation science : examples applying the Pragmatic Robust Implementation and Sustainability Model(PRISM)", MDM policy & practice, 5(2), pp.2381468320963070~ (2020)
  19. Research AfH, Quality, "The SHARE Approach—Essential Steps of Shared Decision-making: Quick Reference Guide", ~ (2020)
  20. (2019)[URL]
  21. "Population covered by public or private health insurance in the UK 2000-2020"[URL]
  22. "Integrated care systems explained: Making sense of systems, places and neighbourhoods"[URL]
  23. Coulter A, "Implementing shared decision making in the UK", Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 105(4), pp.300~304 (2011)
  24. Coulter A, "Engaging patients in healthcare" (2011), McGraw-Hill Education
  25. Coulter A, "Montgomery v Lanarkshire Health Board : transforming informed consent", The Bulletin of the Royal College of Surgeons of England, 99(1), pp.36~38 (2017)
  26. Coulter A, "Shared decision making in the UK : moving towards wider uptake", Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 123, pp.99~103 (2017)
  27. Roberts S, "The Year of Care approach : developing a model and delivery programme for care and support planning in long term conditions within general practice", BMC family practice, 20, pp.1~16 (2019)
  28. Coulter A, "Building the House of Care for people with long-term conditions : the foundation of the House of Care framework", British Journal of General Practice, 66(645), pp.e288~e290 (2016)
  29. "A new service model for the 21st century: 3. People will get more control over their own health and more personalised care when they need it"[URL]
  30. "PRSB SUPPORT SERVICES: Professional Record Standards Body"[URL]
  31. "Gesetzliche und Private Krankenversicherung"[URL]
  32. "PATIENTENRECHTEGESETZ: §§ 630 A BGB FF NEU NORMIERT", ~ (2013)
  33. Rockenbauch K, "Partizipative Entscheidungsfindung(PEF) : eine systematische Übersichtsarbeit zu Begriffsverwendung und Konzeptionen", Das Gesundheitswesen, 73(07), pp.399~408 (2011)
  34. Hahlweg P, "Moving towards patient-centered care and shared decision-making in Germany", Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 171, pp.49~57 (2022)
  35. Scheibler F, "Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany : a pre–post trial", BMJ Evidence-Based Medicine, 29(2), pp.87~95 (2024)
  36. "Verbesserte Arzt-Patienten-Kom−munikation senkt Kosten und erhöht Patientensicherheit"[URL]
  37. G-BA, "EDELL– Entwicklung und Testung eines Instruments zum Einbezug von Shared Decision Making in Leitlinien", ~ (2023)
  38. Schröer-Günther M, "Die informierte Entscheidung als Ziel von evidenzbasierten Gesundheitsinformationen : Das Beispiel Krebsfrüherkennung", Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 65(5), pp.559~566 (2022)
  39. Nationale VersorgungsLeitlinie, "Germany AotSMSi", Association of the Scientific Medical Societies in Germany, ~ (2022)
  40. "Patienteninformation und -beteiligung"[URL]
  41. van der Weijden T, "Shared decision-making in the Netherlands : Progress is made, but not for all. Time to become inclusive to patients", Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 171, pp.98~104 (2022)
  42. van der Weijden T, "Shared decision making, a buzz-word in the Netherlands, the pace quickens towards nationwide implementation…", Zeitschrift fuer Evidenz, Fortbildung und Qualitaet im Gesundheitswesen, 123-124, pp.69~74 (2017)
  43. Samen SB, "Samen beslissen : zo doe je dat", Skipr, 12(9), pp.26~27 (2019)
  44. De Transparantiemonitor 2018, "Bos N", ~, pp.De Transparantiemonitor 2018. Deelrapport: Beslist Samen! (2019)
  45. Damman OC, "The use of PROMs and shared decision-making in medical encounters with patients : an opportunity to deliver value-based health care to patients", Journal of evaluation in clinical practice, 26(2), pp.524~540 (2020)
  46. "Subsidieregeling Leren gebruiken van uitkomstinformatie voor Samen beslissen"[URL]
  47. De Transparantiemonitor 2018: Op weg naar nieuwe invullingen van transparantie, "de Boer D", ~ (2019)
  48. Park, D. J., "Direction of national policy for health literacy in Korea", Korean Journal of Health Education and Promotion, 39(4), pp.1~14 (2022)
  49. 2020 Health and Medical Information Survey, "Lee J-H", Korea Health Information Service, ~ (2021)
  50. Danner M, "Making shared decision-making(SDM)a reality : protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital", BMJ open, 10(10), pp.e037575~ (2020)

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