Our Mission

The Center for Healthcare Decisions’ (CHCD) mission is to advance health and healthcare that reflects the values of an informed public.

Who We Are

Founded in 1994, CHCD was a non-partisan, non-profit organization that merged with the Center for Healthcare Policy and Research at the University of California, Davis (UCD) in 2017. CHCD staff collaborate with UCD researchers and others to promote civic engagement and capture public views on contemporary, controversial, and value-laden health issues. Target audiences for study findings include local, state, and national policymakers, community members, and other stakeholders, such as purchasers and practitioners.

What We Do

  • We identify challenging health policy issues where there is a role for informed public input.
  • We help other health stakeholders – e.g., researchers, community leaders, healthcare organizations, and policymakers – identify the health issues that are relevant to their constituents.
  • We assist researchers with obtaining IRB exceptions to informed consent through facilitating community consultations.
  • We produce, implement, and evaluate customized non-partisan deliberative processes that meet the needs of our partners and clients. Our methods are engaging and include the use of games, scenarios, and surveys.
  • We communicate relevant project findings to inform the work of policymakers and health leaders through presentations, professional publications, and social media.
  • We educate diverse professional and lay groups on the concept of social decision-making in the health and healthcare arenas through the use of interactive discussion groups.


Established in 1994 as Sacramento Healthcare Decisions, the Center for Healthcare Decisions began with two local projects focusing on healthcare reform and end-of-life care.

Our first project related to the Clinton era healthcare reform debate. Exploring personal and societal values, we helped develop an eight-part series in The Sacramento Bee called The Heart of Health Care. But the work that really established our path for many years was the ECHO Project. Responding to national concerns about the use of life-sustaining treatment for dying patients – and who controlled those decisions – we brought together 1,000 community members and healthcare professionals in a three-year effort to improve hospital-based care and communications for those at the end of life. This endeavor sparked tangible changes in local hospitals and became a national model of community collaboration. The ECHO Project led to the creation of the Coalition for Compassionate Care of California, a statewide partnership promoting high-quality, compassionate end-of-life care.

As part of the growing interest in the mid-1990s in improving care at the end of life, CHCD played a leadership role in local, state, and national activities. For nearly two decades, we educated thousands of citizens, trained hundreds of health professionals and faith leaders, and worked with healthcare organizations to implement new end-of-life policies and practices. During that time, CHCD established both the Compassionate Care Alliance of the Greater Sacramento Area and the Sacramento Area POLST Coalition to help move this important work forward. By 2014 CHCD had transitioned its education and outreach activities to other organizations, including the Coalition for Compassionate Care of California.

Beginning in 1999 CHCD expanded its focus beyond end-of-life care to issues related to the rising cost of health care. Through a number of projects, we introduced the public to the concept of setting priorities when resources are limited. This work has broadened our reach from primarily regional to an organization with state and national impact.

End of Life Care

From 1994-2013, CHCD played a leadership role in local, state, and national activities related to improving end-of-life care. Through ECHO - Extreme Care Humane Options - educational materials, trainings and policy recommendations, CHCD educated thousands of citizens, trained hundreds of local health professionals and faith leaders, and worked with healthcare organizations to implement new end-of-life policies and practices. By 2014 CHCD had transitioned its education and outreach activities to other organizations, including the Coalition for Compassionate Care of California (CCCC).

Summary of CHCD activities:

  • Advance Care Planning/POLST speakers bureau. Now being coordinated by the Greater Sacramento Health Ministry Network (GSHMN); contact Susan Carson by email at: Susan.Carson@DignityHealth.org
  • Consumer education materials. Now available through Coalition for Compassionate Care of California
  • Finding Your Way booklets, can be viewed and ordered from the CCCC website.
    To view on their website: Click Here. Then click on the Talking About Advance Care Planning button. That will take you to a PDF of the booklet.
    To purchase quantities in their online store: Click Here.
  • Annual Partners in Caring seminar for faith leaders. Now being sponsored by GSHMN
  • Regional POLST Coalition (2009-2012)
  • Sacramento regional Alliance (2001-2010)
  • Statewide Coalition for Compassionate Care participation (1998-2012)
  • 2011 – wrote an issue brief on a regional collaborative effort to improve advance care planning and end-of-life care in Sacramento area nursing homes
  • 2009 – produced a white paper highlighting the work of eight community POLST coalitions
  • 2005 – co-authored an article in Journal of Palliative Medicine: Improving End-of-Life Care in Nursing Facilities: The Community State Partnership to Improve End-of-Life Care - California

Principal Consultant

Patricia E. Powers, MPA


Patricia E. Powers is a nationally known leader with more than 30 years of experience in the health and health care sectors. She joined the Center for Healthcare Decisions in 2016 and is passionate about ensuring that the public’s views are well represented on complex health policy issues. Since 2009, Ms. Powers has been an independent consultant focused on long-term engagements related to strategic planning, public policy, and program and business development. Ms. Powers’s clients include for-profit and non-profit organizations, state and federal agencies, and foundations. She served as the innovation director for the California Health and Human Services Agency and directed the state-led “Let's Get Healthy California” Task Force; both are efforts designed to advance the Triple Aim in California. For six months she managed the start-up of the California Health Benefit Exchange, now Covered California. In the 1990s, Ms. Powers led and successfully grew two nonprofit organizations, including the Pacific Business Group on Health, and an organization focused on the social determinants of health. She also consulted to and served as interim CEO of an organization focused on telehealth policy. Ms. Powers is a member of the California Technology Assessment Forum and the Integrated Healthcare Association board. Her previous board service includes the National Committee on Quality Assurance, the National Forum for Health Care Quality Measurement and Reporting (now the National Quality Forum), the National Business Coalition on Health, and the Physician Payment Review Commission. Ms. Powers received a master of public administration degree from Columbia University in New York and an undergraduate degree from the University of Michigan.


Research Associate

Susan Perez, PhD, MPH


Susan Perez’s research focuses on understanding consumers’ decision-making processes in order to develop healthcare policies, information, and resources to promote high value decisions . Dr. Perez has conducted studies that classified approaches to processing Internet health information among vulnerable populations; addressed statewide overuse of healthcare services; identified approaches for patients and providers to discuss cost while preserving trust; developed a statewide campaign to address variation in C-section rates by working with both patients and hospitals; and illuminated consumers’ views of cost sharing, quality, and network choice. Prior to her appointment as an assistant professor at California State University, Sacramento, Dr. Perez completed a postdoctoral fellowship in quality, safety, and comparative effectiveness research (supported by the U.S. Agency for Healthcare Research and Quality) and earned a doctorate in Nursing Science and Health-Care Leadership program at the University of California, Davis.


Research Fellow

Karen Shore, Ph.D.


Karen K. Shore, Ph.D. has 25 years of experience in health policy and health services research and a passion for improving the health care system. Dr. Shore's expertise includes project direction, study design, literature reviews, development of data collection materials, quantitative and qualitative data analysis, and recommending policy changes to improve program and organization effectiveness. Most recently, she was a Program Director at the Institute for Clinical and Economic Review (ICER), leading the California Technology Assessment Forum (CTAF) project. Prior to that, Dr. Shore worked in Sacramento health policy at the Center for Health Improvement (CHI) and the Institute for Population Health Improvement at UC Davis. Prior to her work in Sacramento, Dr. Shore held a variety of research and policy positions in the public and private sectors, including at the American Institutes for Research's Health Program, Reden & Anders, Pacific Business Group on Health, and the Prospective Payment Assessment Commission in Washington, DC. She has a master's degree in health services administration from the University of Michigan and a PhD in health services and policy analysis from University of California, Berkeley.


CHCD receives funding from philanthropic grants, contracts with other organizations, donations, honoraria and in-kind contributions. We appreciate the following organizations for their recent or current support:

Grants and Contributions

These organizations support the work of CHCD through project-specific grants or through core funding to further our mission.

California HealthCare Foundation

The California HealthCare Foundation works as a catalyst to fulfill the promise of better health care for all Californians. We support ideas and innovations that improve quality, increase efficiency, and lower the costs of care.

Dignity Health

We are dedicated to delivering high-quality, affordable healthcare services in a compassionate environment that meets each patient’s physical, mental and spiritual needs. Upholding the core values of dignity, justice, stewardship, collaboration, and excellence, our healing philosophy serves not just our patients, but our staff, our communities, and our planet.

Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. Our mission is to provide high-quality, affordable healthcare services and improve the health of our members and the communities we serve. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health.

Blue Shield of California

Blue Shield puts the care of our members first – not profit. As a not-for-profit company, it’s our mission to provide access to high-quality care, health insurance, life insurance, dental and vision coverage to all Californians, at an affordable price.

LeadingAge CA

LeadingAge California is the leading advocate for quality nonprofit senior living and care in the state. The public-interest association represents more than 400 nonprofit providers of aging services – including affordable housing, continuing care retirement communities, assisted living, skilled nursing, and home and community-based care – that collectively serve more than 100,000 seniors.

Sutter Health

Serving patients and their families in more than 100 Northern California cities and towns, Sutter Health doctors, not-for-profit hospitals and other healthcare service providers share resources and expertise to advance health care quality and access. Together, we share a partnership promise to create a more personalized, high-value healthcare experience for our patients and their family.

All contributions are fully tax-deductible.


Through contracts and subcontracts, CHCD assists other private and public sector organizations that seek expertise in developing and implementing deliberative topics with the general public or with specific populations of consumers or healthcare professionals.

University of California, Davis Health System

CHCD is assisting in the development and use of a deliberative process to be applied with an online discussion tool, for identifying research priorities of patients, clinicians and researchers. This is a component of a larger PCORI grant.

American Institutes for Research

CHCD was a subcontractor with AIR’s 3-year AHRQ project, Community Forum (2010-2013). We assisted at all levels of project design, implementation and evaluation, with special emphasis on topic development; creating deliberative tools; facilitating discussion groups; evaluating qualitative findings and preparing the final report.

Covered California

At the request of the state’s health benefit exchange, CHCD designed, implemented and prepared the results of a project to identify the priorities of potential enrollees in establishing a fair patient cost-sharing model that would apply to new plan members.

Coalition for Compassionate Care of California

Recent contracts: 1) adapted CHCD’s curriculum on end-of-life issues for faith leaders for use statewide and trained community coalition leaders interested in bringing the curriculum to their locale; 2) developed an issue brief, Be Prepared: Reducing Nursing Home Transfers Near End of Life.