OBJECTIVES: Shared decision making (SDM) is an essential component of patient centered health care and is important for disease management. However, the association between SDM and healthcare utilization among US adults with multiple comorbidities is not well understood. This study sought to evaluate the association of SDM on healthcare resource utilization among US adults with multiple comorbidities.

METHODS: Data were collected from the 2020 Medical Expenditure Panel Survey (MEPS) for this cross-sectional study. Eligible participants were United States (US) adults with ≥2 comorbidities. The independent variable was SDM (optimal, average, poor), which was determined based on an algorithm of responses to three MEPS items which investigated if the provider asked patients about other treatments, helped patients decide treatments, and explained options to patients. The dependent variable was healthcare utilization which included office, outpatient, and emergency room visits, and inpatient discharges. Logistic regression models, adjusted for demographic characteristics, assessed associations between SDM and each healthcare utilization variable. The analysis maintained the complex survey data and was weighted to produce nationally representative estimates. The a priori alpha value=0.05.

RESULTS: Among 27,805 individuals in the 2020 MEPS data, 6,954 met the eligibility criteria which represented a weighted population of 100,763,597 US adults with ≥2 comorbidities. There was no significant association detected between SDM and any of the four healthcare utilization variables in adjusted logistic regression models. For example, in office visits, poor vs. optimal SDM odds ratio (OR)=1.8, 95% confidence interval (CI)=0.5-5.7; average vs. optimal SDM OR=0.9, 95% CI=0.7-1.2.

CONCLUSIONS: This study found no association between SDM and healthcare utilization among US adults with ≥2 comorbidities. Further research is required to investigate why this may be the case and to investigate how SDM can be improved in this population.