National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (2)
- Antibiotics (1)
- Arthritis (1)
- Blood Pressure (1)
- Brain Injury (1)
- Cancer (3)
- Cancer: Breast Cancer (1)
- Cancer: Colorectal Cancer (2)
- Cancer: Lung Cancer (2)
- Cancer: Prostate Cancer (2)
- Caregiving (2)
- Case Study (3)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (7)
- Clinical Decision Support (CDS) (4)
- Clinician-Patient Communication (9)
- Communication (5)
- Critical Care (1)
- Cultural Competence (1)
- Data (1)
- (-) Decision Making (58)
- Dementia (1)
- Diabetes (1)
- Diagnostic Safety and Quality (3)
- Disabilities (1)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (7)
- Elderly (3)
- Electronic Health Records (EHRs) (3)
- Emergency Department (3)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (8)
- Falls (1)
- Guidelines (6)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Costs (3)
- Healthcare Delivery (5)
- Healthcare Utilization (2)
- Health Information Technology (HIT) (6)
- Health Services Research (HSR) (3)
- Heart Disease and Health (1)
- Hospital Discharge (1)
- Hospitals (2)
- Infectious Diseases (1)
- Injuries and Wounds (1)
- Inpatient Care (2)
- Intensive Care Unit (ICU) (1)
- Kidney Disease and Health (1)
- Low-Income (1)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medication (4)
- Newborns/Infants (1)
- Nursing Homes (1)
- Obesity (1)
- Obesity: Weight Management (1)
- Outcomes (1)
- Palliative Care (1)
- Patient-Centered Healthcare (5)
- Patient-Centered Outcomes Research (6)
- Patient and Family Engagement (8)
- Patient Experience (2)
- Patient Safety (6)
- Practice Patterns (3)
- Pregnancy (2)
- Pressure Ulcers (1)
- Prevention (4)
- Primary Care (1)
- Provider (1)
- Provider: Health Personnel (1)
- Provider: Nurse (1)
- Provider: Physician (2)
- Quality of Care (3)
- Racial and Ethnic Minorities (3)
- Registries (2)
- Research Methodologies (3)
- Respiratory Conditions (1)
- Risk (3)
- Rural Health (1)
- Screening (4)
- Sleep Problems (2)
- Social Stigma (1)
- Surgery (2)
- Tools & Toolkits (2)
- Training (1)
- Transplantation (4)
- Treatments (1)
- U.S. Preventive Services Task Force (USPSTF) (2)
- Vaccination (2)
- Women (1)
- Young Adults (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 58 Research Studies DisplayedKistler CE, Golin C, Morris C
Design of a randomized clinical trial of a colorectal cancer screening decision aid to promote appropriate screening in community-dwelling older adults.
This paper reports on the design of a randomized clinical trial to understand the effects of a patient decision aid on appropriate colorectal cancer screening. The study aims to determine the ability of a patient decision aid to increase individualized and appropriate colorectal cancer screening.
AHRQ-funded; HS021133.
Citation: Kistler CE, Golin C, Morris C .
Design of a randomized clinical trial of a colorectal cancer screening decision aid to promote appropriate screening in community-dwelling older adults.
Clin Trials 2017 Dec;14(6):648-58. doi: 10.1177/1740774517725289..
Keywords: Cancer, Cancer: Colorectal Cancer, Decision Making, Elderly, Prevention, Screening
Tamirisa NP, Goodwin JS, Kandalam A
Patient and physician views of shared decision making in cancer.
The aim of the study was to explore patient and physician perceptions of shared decision making in clinical encounters for cancer care. Among the study’s multiple conclusions was that most physicians reported providing patients with written information, however, most patients reported that written information was too detailed and felt that the physicians did not assess the level of information they wished to receive.
AHRQ-funded; HS022134.
Citation: Tamirisa NP, Goodwin JS, Kandalam A .
Patient and physician views of shared decision making in cancer.
Health Expect 2017 Dec;20(6):1248-53. doi: 10.1111/hex.12564..
Keywords: Cancer, Decision Making, Patient-Centered Healthcare, Patient Experience, Clinician-Patient Communication
Wang J, Gong Y
Potential of decision support in preventing pressure ulcers in hospitals.
The development of hospital-acquired pressure ulcers signals low quality of care. To meet the challenges of consistently translating best practices into effective clinical practices and promote effective teamwork communication and interprofessional collaboration, the authors consider the failure of consistent care delivery as loss of information and reveal the opportunities of informatics methods to reinforce information delivery, evidenced by typical cases. They then explain and summarize information-related issues existing at the initial assessment upon hospital admission, routine treatments, and team communication.
AHRQ-funded; HS022895.
Citation: Wang J, Gong Y .
Potential of decision support in preventing pressure ulcers in hospitals.
Stud Health Technol Inform 2017;241:15-20.
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Keywords: Clinical Decision Support (CDS), Decision Making, Hospitals, Patient Safety, Pressure Ulcers, Prevention
Maas MB, Francis BA, Sangha RS
Refining prognosis for intracerebral hemorrhage by early reassessment.
The researchers compared the accuracy of a widely used prognostic score against a model derived from clinical data obtained 5 days after admission for patients with intracerebral hemorrhage (ICH), a condition for which prognostication has proven notoriously challenging and prone to bias. They found that a simple reassessment after 5 days of care significantly improves the accuracy of prognosticating outcome in patients with ICH.
AHRQ-funded; HS023437.
Citation: Maas MB, Francis BA, Sangha RS .
Refining prognosis for intracerebral hemorrhage by early reassessment.
Cerebrovasc Dis 2017;43(3-4):110-16. doi: 10.1159/000452679.
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Keywords: Decision Making, Diagnostic Safety and Quality, Patient-Centered Outcomes Research
Schaffhausen CR, Bruin MJ, Chesley D
What patients and members of their support networks ask about transplant program data.
This study used qualitative document research methods to review 678 detailed Scientific Registry of Transplant Recipients (SRTR) entries and summary counts of 55 362 United Network for Organ Sharing (UNOS) entries to provide a better understanding of what was asked and what requests were most common. Patients sought a wide range of information about outcomes, waiting times, program volumes, and willingness to perform transplants in candidates with specific diseases or demographics.
AHRQ-funded; HS024527.
Citation: Schaffhausen CR, Bruin MJ, Chesley D .
What patients and members of their support networks ask about transplant program data.
Clin Transplant 2017 Dec;31(12). doi: 10.1111/ctr.13125.
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Keywords: Education: Patient and Caregiver, Decision Making, Health Services Research (HSR), Registries, Transplantation
Magnusson DM, Minkovitz CS, Kuhlthau KA
AHRQ Author: Mistry KB
Beliefs regarding development and early intervention among low-income African American and Hispanic mothers.
This study sought to understand the role of health beliefs in shaping maternal decisions regarding help-seeking for children with developmental delay (DD) and explore differences between African American and Hispanic mothers. Five major themes emerged describing the role of maternal health beliefs in shaping key stages of the help-seeking pathway for children with DD. Differences between African American and Hispanic mothers are also described.
AHRQ-authored.
Citation: Magnusson DM, Minkovitz CS, Kuhlthau KA .
Beliefs regarding development and early intervention among low-income African American and Hispanic mothers.
Pediatrics 2017 Nov;140(5):pii: e20172059. doi: 10.1542/peds.2017-2059.
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Keywords: Children/Adolescents, Decision Making, Disabilities, Low-Income, Racial and Ethnic Minorities
Colla CH, Mainor AJ
Choosing Wisely Campaign: valuable for providers who knew about it, but awareness remained constant, 2014-17.
The Choosing Wisely campaign has codified recommendations of which health care services' use should be questioned and discussed with patients. The ABIM Foundation administered surveys in 2014 and 2017 to examine physicians' attitudes toward and awareness of the use of low-value care. There were no significant changes between 2014 and 2017 in awareness of the campaign among physicians or physician-reported difficulty in talking to patients about avoiding a low-value service.
AHRQ-funded; HS023812.
Citation: Colla CH, Mainor AJ .
Choosing Wisely Campaign: valuable for providers who knew about it, but awareness remained constant, 2014-17.
Health Aff 2017 Nov;36(11):2005-11. doi: 10.1377/hlthaff.2017.0945.
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Keywords: Decision Making, Guidelines, Quality of Care, Health Services Research (HSR), Clinician-Patient Communication
Probst MA, Kanzaria HK, Schoenfeld EM
Shared decisionmaking in the emergency department: a guiding framework for clinicians.
The authors developed a simple framework to illustrate how shared decisionmaking should be approached in clinical practice. They believe it should be the preferred or default approach to decisionmaking, except in clinical situations in which 3 factors interfere. These 3 factors are lack of clinical uncertainty or equipoise, patient decisionmaking ability, and time, all of which can render shared decisionmaking infeasible. The authors next discuss how to address each factor.
AHRQ-funded; HS021271; HS024311.
Citation: Probst MA, Kanzaria HK, Schoenfeld EM .
Shared decisionmaking in the emergency department: a guiding framework for clinicians.
Ann Emerg Med 2017 Nov;70(5):688-95. doi: 10.1016/j.annemergmed.2017.03.063.
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Keywords: Decision Making, Emergency Department, Emergency Medical Services (EMS), Evidence-Based Practice, Guidelines
Halbert CH, Jefferson M, Melvin CL
Provider advice about weight loss in a primary care sample of obese and overweight patients.
In this study the investigators examined receipt of provider advice to lose weight among primary care patients who were overweight and obese. The investigators found that patient beliefs about their weight status and perceptions about shared decision-making are important to receiving provider advice about weight loss/management among primary care patients.
AHRQ-funded; HS023047.
Citation: Halbert CH, Jefferson M, Melvin CL .
Provider advice about weight loss in a primary care sample of obese and overweight patients.
J Prim Care Community Health 2017 Oct;8(4):239-46. doi: 10.1177/2150131917715336..
Keywords: Decision Making, Obesity, Obesity: Weight Management, Practice Patterns, Primary Care
Herc E, Patel P, Washer LL
A model to predict central-line-associated bloodstream infection among patients with peripherally inserted central catheters: the MPC Score.
Peripherally inserted central catheters (PICCs) are associated with central-line-associated bloodstream infections (CLABSIs). However, no tools to predict risk of PICC-CLABSI have been developed. The purpose of this study is to operationalize or prioritize CLABSI risk factors when making decisions regarding the use of PICCs using a risk model to estimate an individual's risk of PICC-CLABSI prior to device placement.
AHRQ-funded; HS022835.
Citation: Herc E, Patel P, Washer LL .
A model to predict central-line-associated bloodstream infection among patients with peripherally inserted central catheters: the MPC Score.
Infect Control Hosp Epidemiol 2017 Oct;38(10):1155-66. doi: 10.1017/ice.2017.167..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Decision Making, Healthcare-Associated Infections (HAIs), Patient Safety
Pigott T, Noyes J, Umscheid CA
AHRQ series on complex intervention systematic reviews-paper 5: advanced analytic methods.
In this paper, the authors emphasize that the specific research question posed in the review should be used as a guide for choosing the appropriate analytic method. They present advanced analytic approaches that address some common questions that guide reviews of complex interventions such as: (1) How effective is the intervention? and (2) For whom does the intervention work and in what contexts?
AHRQ-funded; 290-2012-00004C; 290-2015-00005I; 290-2015-00004I; 290-2015-00009I; 290-2015-00013I; 290-2015-00011I; 290-2015-00003I.
Citation: Pigott T, Noyes J, Umscheid CA .
AHRQ series on complex intervention systematic reviews-paper 5: advanced analytic methods.
J Clin Epidemiol 2017 Oct;90:37-42. doi: 10.1016/j.jclinepi.2017.06.015.
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Keywords: Decision Making, Evidence-Based Practice, Guidelines, Research Methodologies
Davis CM, Guo M, Miyamura J
Key factors in obstetric delivery decision-making among Asian and Pacific Islander women by English proficiency.
Understanding (1) how expectant mothers gather information to decide where to give birth, and (2) who helps make that decision, provides critical health communication and decision-making insights. This survey found that the top three health decision-makers for both those Asian American and Pacific Islanders (AAPIs) with limited English proficiency and English-proficient AAPIs were themselves, their obstetrician, and their spouse, which did not differ significantly by language proficiency.
AHRQ-funded; HS021903.
Citation: Davis CM, Guo M, Miyamura J .
Key factors in obstetric delivery decision-making among Asian and Pacific Islander women by English proficiency.
Hawaii J Med Public Health 2017 Oct;76(10):279-86.
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Keywords: Healthcare Delivery, Cultural Competence, Decision Making, Pregnancy, Racial and Ethnic Minorities
Fan T, Rogers A
AHRQ Author: Fan T
Screening for syphilis infection in nonpregnant adults and adolescents.
R.J. is a 27-year-old man who presents for a well-patient visit. He always keeps his appointments and likes to make sure he is healthy. R.J. has started a new relationship and asks if he should be screened for syphilis. The case study asks a series of three questions based on the USPSTF recommendation statement. Answers are provided.
AHRQ-authored.
Citation: Fan T, Rogers A .
Screening for syphilis infection in nonpregnant adults and adolescents.
Am Fam Physician 2017 Sep 15;96(6):393-94.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Decision Making, Infectious Diseases, Case Study
Holland DE, Brandt C, Targonski PV
Validating performance of a hospital discharge planning decision tool in community hospitals.
The researchers aimed to determine the predictive performance of the Early Screen for Discharge Planning (ESDP) in a rural regional community hospital practice setting. Patients with high ESDP scores reported more problems after discharge, reported lower quality of life, had longer length of stays, and used post-acute care services more than patients with low ESDP scores.
AHRQ-funded; HS022923.
Citation: Holland DE, Brandt C, Targonski PV .
Validating performance of a hospital discharge planning decision tool in community hospitals.
Prof Case Manag 2017 Sep/Oct;22(5):204-13. doi: 10.1097/ncm.0000000000000233.
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Keywords: Decision Making, Hospital Discharge, Outcomes, Rural Health, Tools & Toolkits
Lee BY, Haidari LA
The importance of vaccine supply chains to everyone in the vaccine world.
The study authors detail how vaccine supply chains may affect the work and decision making of ten examples of different members of the vaccine community: preclinical vaccinologists, vaccine clinical trialists, vaccine package designers, health care workers, epidemiologists and disease surveillance experts, policy makers, storage equipment manufacturers, other technology developers, information system specialists, and funders.
AHRQ-funded; HS023317.
Citation: Lee BY, Haidari LA .
The importance of vaccine supply chains to everyone in the vaccine world.
Vaccine 2017 Aug 16;35(35 Pt A):4475-79. doi: 10.1016/j.vaccine.2017.05.096..
Keywords: Decision Making, Vaccination
Fan T, Amobi A
AHRQ Author: Fan T
Screening for gynecologic conditions with pelvic examination.
A 37-year-old woman presents to your office for her annual wellness visit. She is not due for a Papanicolaou (Pap) smear this year. She is not pregnant, reports no problems, and has no risk factors for sexually transmitted infections. She asks if she should have a pelvic examination today. The case study asks a series of three questions based on the USPSTF recommendation statement. Answers are provided.
AHRQ-authored.
Citation: Fan T, Amobi A .
Screening for gynecologic conditions with pelvic examination.
Am Fam Physician 2017 Aug 15;96(4):253-54.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Women, Case Study, Decision Making, Screening
Berger ZD, Boss EF, Beach MC
Communication behaviors and patient autonomy in hospital care: a qualitative study.
Researchers conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. They concluded that shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict.
AHRQ-funded; HS022932.
Citation: Berger ZD, Boss EF, Beach MC .
Communication behaviors and patient autonomy in hospital care: a qualitative study.
Patient Educ Couns 2017 Aug;100(8):1473-81. doi: 10.1016/j.pec.2017.03.006.
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Keywords: Communication, Decision Making, Inpatient Care, Clinician-Patient Communication
Dykes PC, Duckworth M, Cunningham S
Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit.
Patient falls during an acute hospitalization cause injury, reduced mobility, and increased costs. The laminated paper Fall TIPS Toolkit (Fall TIPS) provides clinical decision support at the bedside by linking each patient's fall risk assessment with evidence-based interventions. The investigators examined strategies to integrate this evidence into clinical practice. They concluded that engaging hospital and clinical leadership is critical in translating evidence-based care into clinical practice. They address and detail barriers to adoption of the protocol to provide guidance for spread to other institutions.
AHRQ-funded; HS025128.
Citation: Dykes PC, Duckworth M, Cunningham S .
Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit.
Jt Comm J Qual Patient Saf 2017 Aug;43(8):403-13. doi: 10.1016/j.jcjq.2017.05.002..
Keywords: Clinical Decision Support (CDS), Decision Making, Evidence-Based Practice, Falls, Hospitals, Injuries and Wounds, Inpatient Care, Patient Safety, Prevention, Risk, Tools & Toolkits
Wang SY, Kelly G, Gross C
Information needs of older women with early-stage breast cancer when making radiation therapy decisions.
The researchers identified the information older women with early-stage breast cancer need when making radiation therapy decisions, and who patients identify as the main decision maker. They found that older women consider themselves to be the main decision maker; they desire information and have more agency and input in the decision-making process than prior literature would suggest.
AHRQ-funded; HS023900.
Citation: Wang SY, Kelly G, Gross C .
Information needs of older women with early-stage breast cancer when making radiation therapy decisions.
Int J Radiat Oncol Biol Phys 2017 Jul 15;98(4):733-40. doi: 10.1016/j.ijrobp.2017.02.001.
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Keywords: Cancer: Breast Cancer, Decision Making, Education: Patient and Caregiver, Treatments
Ashby VB, Leichtman AB, Rees MA
A kidney graft survival calculator that accounts for mismatches in age, sex, HLA, and body size.
Models were adjusted for year of transplant and donor and recipient characteristics, with particular attention to mismatches in age, sex, human leukocyte antigens (HLA), body size, and weight. These models were used to create a calculator of estimated graft survival for living donors. This calculator provides useful information to donors, candidates, and physicians of estimated outcomes and potentially in allowing candidates to choose among several living donors.
AHRQ-funded; HS020610.
Citation: Ashby VB, Leichtman AB, Rees MA .
A kidney graft survival calculator that accounts for mismatches in age, sex, HLA, and body size.
Clin J Am Soc Nephrol 2017 Jul 7;12(7):1148-60. doi: 10.2215/cjn.09330916.
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Keywords: Adverse Events, Decision Making, Registries, Risk, Transplantation
Meyer AND, Singh H
Calibrating how doctors think and seek information to minimise errors in diagnosis.
This editorial discusses a study by Sheringham et al., published in 2017 in BMJ Quality and Safety, and entitled “Variations in GPs’ decisions to investigate suspected lung cancer: a factorial experiment using multimedia vignettes” in which they used simulated patient vignettes to understand the role that patient characteristics (including demographics and symptomatology) play in physicians’ decisions to investigate for possible diagnosis of lung cancer.
AHRQ-funded; HS022087; HS023602.
Citation: Meyer AND, Singh H .
Calibrating how doctors think and seek information to minimise errors in diagnosis.
BMJ Qual Saf 2017 Jun;26(6):436-38. doi: 10.1136/bmjqs-2016-006071..
Keywords: Cancer: Lung Cancer, Decision Making, Diagnostic Safety and Quality
Iyer AS, Bakitas M
Early palliative care in advanced illness: do right by mama.
This letter describes a case study where the doctor and the family decided not to do aggressive treatment on their mother in her 80’s with metastatic lung cancer and pneumonia. After describing the intubation procedure and the use of mechanical ventilation, the family decided that palliative care was the best option. The doctor emphasizes the use of palliative care as the best outcome for many terminally ill patients.
AHRQ-funded; HS023009; HS013852.
Citation: Iyer AS, Bakitas M .
Early palliative care in advanced illness: do right by mama.
JAMA Intern Med 2017 Jun;177(6):761-62. doi: 10.1001/jamainternmed.2017.0764.
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Keywords: Cancer, Cancer: Lung Cancer, Case Study, Decision Making, Elderly, Palliative Care, Patient-Centered Outcomes Research
Barlow SE, Turer CB
Lipid screening and treatment practices conflict with conflicting recommendations: where do we go from here?
This article comments on a 2017 study by de Ferranti, et al., published in the Journal of Pediatrics, which reported results from a survey of US pediatricians’ knowledge and implementation of child and adolescent cholesterol screening and treatment guidelines.
AHRQ-funded; HS022418.
Citation: Barlow SE, Turer CB .
Lipid screening and treatment practices conflict with conflicting recommendations: where do we go from here?
J Pediatr 2017 Jun;185:16-18. doi: 10.1016/j.jpeds.2017.02.041..
Keywords: Children/Adolescents, Heart Disease and Health, Decision Making, Guidelines
Melnick ER, Hess EP, Guo G
Patient-centered decision support: formative usability evaluation of integrated clinical decision support with a patient decision aid for minor head injury in the emergency department.
The study’s objective was to formatively evaluate an electronic tool that not only helps clinicians at the bedside to determine the need for CT use based on the Canadian CT Head Rule but also promotes evidence-based conversations between patients and clinicians regarding patient-specific risk and patients' specific concerns. It concluded that the Concussion or Brain Bleed app is a useful and usable final product integrating clinical decision support with a patient decision aid.
AHRQ-funded; HS021271.
Citation: Melnick ER, Hess EP, Guo G .
Patient-centered decision support: formative usability evaluation of integrated clinical decision support with a patient decision aid for minor head injury in the emergency department.
J Med Internet Res 2017 May 19;19(5):e174. doi: 10.2196/jmir.7846.
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Keywords: Brain Injury, Decision Making, Emergency Department, Health Information Technology (HIT), Patient-Centered Healthcare
Morgan DJ, Leppin AL, Smith CD
A practical framework for understanding and reducing medical overuse: conceptualizing overuse through the patient-clinician interaction.
The authors used an iterative, expert-informed, evidence-based process to develop a framework for conceptualizing interventions to reduce medical overuse. Given the complexity of defining and identifying overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient-clinician interaction as the nexus of decisions regarding inappropriate care.
AHRQ-funded; HS018111.
Citation: Morgan DJ, Leppin AL, Smith CD .
A practical framework for understanding and reducing medical overuse: conceptualizing overuse through the patient-clinician interaction.
J Hosp Med 2017 May;12(5):346-51. doi: 10.12788/jhm.2738.
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Keywords: Decision Making, Healthcare Delivery, Quality of Care, Healthcare Utilization, Clinician-Patient Communication