DA Selection and Patient Eligibility


An early step in effective program implementation is determining what DAs to use at your clinic. Start small and select and implement a few priority DAs in the clinic to get started. Then, if it is feasible for your clinic, slowly add and expand the DA selection over time. This approach reduces the likelihood that staff and clinicians will be overwhelmed during the initial phase of implementation and helps deter DA saturation over time.

Selecting Priority DAs
Engaging clinicians and staff is essential to determine which DAs will be well received in your clinic. You can use one or a combination of approaches to decide which DA topics are best for your clinic. Starting with a subset of priority DAs (maximum of three) will help your clinic develop and refine the implementation process and allow you to expand to additional DAs over time.

Consider using one of the following DA selection strategies:

  • Clinic-Wide Voting System: One method is to hold clinic-wide meetings (possibly in conjunction with regular weekly staff meetings) or focus groups to determine what the staff perceives as a need in the clinic. Is diabetes a challenge for nurses to address? Do patients ask the referral coordinator about surgical options? Is weight loss surgery something patients are asking about frequently?
  • Supplement Existing Clinic Resources: DAs can serve as a supplement to your clinic’s educational resources. Many clinics, especially those located in rural areas, do not have adequate resources for patient education or health behavior change.
  • Local Statistics: Local statistics on chronic conditions, surgical procedures and community demographics have proven useful in targeting a need for resources in the community. For example, if statistics show that 67% of your population is women over the age of 40, implementing a DA on menopause may be a useful strategy to educate this specific, but large population about treatment options.
  • Unwarranted Variations: Clinics may choose to explore unwarranted variations in care for their hospital region using the online Dartmouth Atlas. If there are unusually high or low rates of certain procedures (i.e., lower back surgery, knee surgery, etc.) primary care clinics may choose to equip patients with the appropriate DA prior to or at the time of referral to a specialist.
  • Engaging Patients in DA Selection: Clinics that have patient advisory boards may elect to ask patients what DAs would be most relevant to the local population. This approach can help raise community awareness and may lead to patients ordering their own DAs!

There are pros and cons in choosing DAs that focus on chronic conditions (diabetes) vs. specific surgical procedures (colonoscopy) or more rare situations (weight loss surgery). Having a discussion about these pros and cons can be helpful in determining which DA will work for your clinic. Consider these questions:

  • Which DAs will gain maximum exposure?
  • Which DAs would be good supplements for viewing before procedural referrals?
  • Which DAs will sustain in the clinic without saturating the population?
  • Which DAs are the staff (and clinicians) excited about?
  • Which DAs do patients want their health care teams to provide?*

*While clinicians are experts at diagnosing medical conditions, it is more difficult to gauge patient preference. Engaging patients in determining priority DAs is a great way to include them in the SDM/DA project and increase community awareness about your clinic’s emphasis on quality improvement, evidence-based, and patient-centered care. Moreover, engaging patients in the DA selection process may provide strategies to market the DAs and encourage patient viewing.

Determining Eligibility Criteria for DAs
Many clinics may elect to use the eligibility criteria provided in each DA tool. However some practices may elect to narrow their criteria to offer DAs to patients when they’re presenting for an annual exam or with a specific condition as their chief complaint. Refinement of eligibility criteria may be necessary over time based on clinic capacity for distribution and tracking of DAs.


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