Identifying Patients and Distributing DAs


In addition to clarifying eligibility criteria for the DAs, you will need to determine which personnel will identify patients as eligible in actual practice. At some clinics, multiple personnel are involved in patient identification. These are some of the successful individuals/roles who have been involved in identifying patients in our Oregon clinics:

  • Front Office Staff/Reception: These individuals are often the first point of contact in a clinic. Reception staff clarify the reason for patient appointments and they may be able to flag clinicians or back office staff that a patient is eligible for DAs related to chronic conditions, end of life decisions, or screening exams. A strong team-based clinic atmosphere supports engagement of the front office staff in this process. Additional training or coaching may help these staff members gain confidence in identifying eligible patients.
  • Medical Assistant (MA) or RN: Medical Assistants or RNs are often able to review or “scrub” the patient list and medical chart first thing in the morning to identify specific conditions. They can let the clinician know that the patient may be appropriate before the appointment time. MA/RNs are also essential in gathering additional information from the patient as they are placing them in the exam room. The clinics we worked with pinpointed these roles as the most resourceful in identifying eligible patients.
  • Clinician: Clinicians can identify eligible patients during the appointment time, while developing a plan of care, and through recommendations made by their MA/RN.
  • Nurse Care Coordinator: Not all clinics are lucky enough to have someone in this position. If you are, the nurse care coordinator can be utilized when specific populations are targeted for distribution or when clinicians submit referrals for follow-up for certain chronic conditions. They can also be key personnel for follow-up visits.
  • Electronic Medical Records: Incorporating any (or all) of the above strategies with your EMR system provides the most resource efficient method to identify patients and distribute DAs. Your EMR needs to be set to flag patients who meet the specific eligibility criteria for your clinic’s priority DAs (i.e., PSA testing = Male age 60 here for complex physical exam; Diabetes = Problem list diagnosis of DM with HbA1c above 8 on last test; Aging = Male or Female over age 50).

Determining When to Distribute the DA
You need to determine the most appropriate time for DA distribution. There is no right or wrong answer – every clinic visit flows differently so it helps to be flexible and have multiple approaches available. Here are several options:

  • Prior to the visit: Clinics mail DAs to patients based on established criteria (age category reached, type of appointment).
  • During the visit (by MA or clinician): The clinician presents the DA to the patient during their appointment.
  • After the visit (by MA/RN): After the clinician has discussed DA topic, the MA/RN presents the DA packet to the patient.
  • After the patient has left the clinic: A protocol can be established for contacting the patient after the visit to discuss the DA, and the MA/RN or front desk staff can mail the materials to the patient. This option is useful if you forget or don’t have the time during the office visit.

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Distributing the DA in the exam room is popular in many rural clinics because it is a private space that allows for an open, one-on-one dialogue about the patient’s medical condition. Staff can present the DA to the patient immediately (before the conversation trail is lost).

When initiating a discussion with the patient, make sure to have talking points and be ready to address any questions the patient might have.

  • Why is our clinic using the Shared Decision Making approach?
  • What does the patient have to do? Is there any follow-up?
  • Why did we identify this patient?

Clinicians can use different approaches when presenting the DAs to patients, but there are some key points you should address:

  • Explain that the DVD and booklet has evidence-based information about the condition
  • Encourage the patient to make an appointment so that they can discuss their choice and make a treatment plan.


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