Conclusion
Shared decision-making is an essential process that is often impeded by
the complexity of our medical system. The proposed model serves to
distill the complexity by forming a SDM microsystem around each patient.
Such a microsystem would offer continuity by transcending changes in
time, personnel and sites of care. The SDM microsystem for each patient
could be formed and integrated into the work of acute care microsystems,
such as the PICU, as needed. This staged, microsystem approach would
allow for the flexibility needed to assemble the unique combination of
people and information needed for each child, and would also provide
enough structure to promote reproducibility and enable systematic
evaluation of the process. Reproducibility and measurement will be
essential for developing appropriate value-based payment systems for
SDM. Prospective research studies would be needed to determine the
feasibility of such an approach as well as to develop and evaluate
measures of the quality of the SDM process. This conceptual model could
be expanded to other medically complex populations of all ages for whom
shared decision making is needed.