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220 Early adoption of shared decision making in an implementation-effectiveness study: implications for clinical champions and implementation facilitation
  1. Megan E Branda1,
  2. Jennifer L Ridgeway1,2,
  3. Victor M Montori1,3
  1. 1Knowledge and Evaluation Research Unit, Mayo Clinic, Minnesota, USA
  2. 2Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Minnesota, USA
  3. 3Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Minnesota, USA


Shared decision making (SDM) is guideline-recommended for cardiovascular (CV) risk prevention1 and may address common discordance between individual risk and treatment intensity, but SDM is not widely adopted in preventive care settings. As part of an implementation-effectiveness pragmatic trial in three U.S. healthcare systems, we conducted surveys and site visits of pre-implementation context, embedded an SDM tool for CV preventive care conversations in electronic health records (EHR), and are deploying targeted implementation strategies to increase adoption of the tool.2 Assessment of early adoption (i.e., clinicians who took up the practice earliest) informed targeted implementation strategies, including identification of peer champions. This symposium will share our team’s experience engaging clinicians, information technology, and other research partners in three health systems to develop and document EHR infrastructure for assessing SDM tool adoption. We will share our virtual approach for training implementation facilitators and identifying and preparing clinical champions and provide examples of ways in which clinician surveys, site visits, and EHR reports on clinician adoption and patient reach have been used to identify early adopters and map implementation strategies to identifiable barriers. The symposium will include a team-based presentation mode followed by attendee engagement related to strategies for adoption of EHR-enabled SDM in preventive care settings. To date, 125 clinicians have used the tool in 4500 clinical encounters. More than half of clinicians who adopted the tool after EHR integration did so before implementation strategies commenced (i.e., early adopters). Attitudes toward SDM and impressions of EHR use in patient care were positive among adopters and non-adopters. Sites with high numbers of early adopters also had high numbers of late adopters and limited non-adopters; sites with low early adoption had high rates of non-adoption, even when late adoption was at least moderate.


  1. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd- Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC Jr, Virani SS, Williams KA Sr, Yeboah J, Ziaeian B. 2019; ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the american college of cardiology/american heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2019;74(10):1429–1430.

  2. Ridgeway JL, Branda ME, Gravholt D, Brito JP, Hargraves IG, Hartasanchez SA Leppin, AL, Gomez, YL, Mann, DM, Nautiyal, V Thomas, RJ Behnken, EM, Torres Roldan, VD, Shah, ND, Khurana, CS, Montori, VM, Increasing risk-concordant cardiovascular care in diverse health systems: a mixed methods pragmatic stepped wedge cluster randomized implementation trial of shared decision making (SDM4IP). Implement Sci Commun. 2021;2(1):43.

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