National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (3)
- Back Health and Pain (1)
- Behavioral Health (1)
- Cancer (1)
- Cardiovascular Conditions (1)
- Care Management (2)
- Children/Adolescents (1)
- (-) Chronic Conditions (23)
- (-) Clinician-Patient Communication (23)
- Communication (12)
- COVID-19 (1)
- Diabetes (2)
- Diagnostic Safety and Quality (1)
- Dialysis (1)
- Digestive Disease and Health (2)
- Electronic Health Records (EHRs) (1)
- Healthcare Delivery (2)
- Health Information Technology (HIT) (5)
- Heart Disease and Health (1)
- Human Immunodeficiency Virus (HIV) (1)
- Imaging (1)
- Kidney Disease and Health (1)
- Lifestyle Changes (1)
- Medicaid (1)
- Medication (3)
- Nursing (1)
- Nutrition (2)
- Opioids (2)
- Pain (3)
- Palliative Care (1)
- Patient-Centered Healthcare (5)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Patient and Family Engagement (5)
- Patient Experience (3)
- Patient Self-Management (5)
- Primary Care (3)
- Primary Care: Models of Care (2)
- Provider (2)
- Provider: Nurse (1)
- Quality Improvement (1)
- Quality of Care (1)
- Respiratory Conditions (1)
- Shared Decision Making (5)
- Sickle Cell Disease (1)
- Social Stigma (1)
- Transitions of Care (1)
- Treatments (1)
- Web-Based (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 23 of 23 Research Studies DisplayedZisman-Ilani Y, Thompson KD, Siegel LS
Crohn's disease shared decision making intervention leads to more patients choosing combination therapy: a cluster randomised controlled trial.
The purpose of this multi-site cluster randomised controlled trial was to test the impact of standard Crohn's disease care and compare with the impact of shared decision making (SDM) on the provider’s choice of therapy, quality of decisions, and provider trust. A total of 158 adult patients with Crohn's disease within 15 years of their diagnosis, with no prior Crohn's disease complications, and who were candidates to receive immunomodulators or biologics, from 14 diverse gastroenterology practices in the US, participated in the study. 99 of those participants received the intervention and 59 received standard care. The study found that participants in the intervention group chose combination therapy more frequently, had a significantly lower decisional conflict, and had greater trust in their provider.
AHRQ-funded; HS021747.
Citation: Zisman-Ilani Y, Thompson KD, Siegel LS .
Crohn's disease shared decision making intervention leads to more patients choosing combination therapy: a cluster randomised controlled trial.
Aliment Pharmacol Ther 2023 Jan;57(2):205-14. doi: 10.1111/apt.17286..
Keywords: Digestive Disease and Health, Chronic Conditions, Shared Decision Making, Patient-Centered Healthcare, Clinician-Patient Communication
Schuttner L, Hockett Sherlock S, Simons CE
My goals are not their goals: barriers and facilitators to delivery of patient-centered care for patients with multimorbidity.
This study’s goal was to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. The authors conducted semi-structured telephone interviews from April to July 2020 with 23 physicians across 20 clinical sites, with most being female (61%). Facilitators included: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients' psychosocial contexts. Barriers included: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care.
AHRQ-funded; HS026369.
Citation: Schuttner L, Hockett Sherlock S, Simons CE .
My goals are not their goals: barriers and facilitators to delivery of patient-centered care for patients with multimorbidity.
J Gen Intern Med 2022 Dec;37(16):4189-96. doi: 10.1007/s11606-022-07533-1..
Keywords: Patient-Centered Healthcare, Healthcare Delivery, Chronic Conditions, Clinician-Patient Communication, Communication, Patient and Family Engagement
Fisher KA, Kennedy K, Bloomstone S
Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD.
The purpose of this study was to explore the effect of physicians sharing their clinical notes with patients with chronic obstructive pulmonary disease (COPD) and assess the impact on patient-physician communication and patient self-management. The researchers conducted interviews with 30 patients with COPD, asking them to review their clinic notes. The participants were primarily White (93.3%) with an average age of 65.5 years; more than 50% reported having a high school degree or less, almost half reported sometimes requiring help to read medical materials, and half had challenges understanding spoken information. The study found that patients reported that having the clinic notes gave them an opportunity to learn more about their condition, and encouraged their self-management by reminding them of their action steps, serving as prompts for seeking information, and motivating them. Patients indicated positive reactions to those physician notes that implied their clinician considered them as a person, listened to them, and noticed details about them. The majority of patients reported negative reactions to incorrect information in the notes, wording that they considered disapproving, and medical terms. The study concluded that the act of providers sharing their clinical notes with their patients can serve multiple purposes, including encouraging the exchange of information and self-management, and improving the relationship between patients and providers.
AHRQ-funded; HS024596.
Citation: Fisher KA, Kennedy K, Bloomstone S .
Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD.
Patient Educ Couns 2022 Mar;105(3):726-33. doi: 10.1016/j.pec.2021.06.004..
Keywords: Respiratory Conditions, Chronic Conditions, Clinician-Patient Communication, Communication, Patient Self-Management
Kunneman M, Branda ME, Ridgeway JL
Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention.
The purpose of this trial was to determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. Findings showed that using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence, or improved diabetes control in patients with type 2 diabetes.
AHRQ-funded; HS018339.
Citation: Kunneman M, Branda ME, Ridgeway JL .
Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention.
Endocrine 2022 Feb;75(2):377-91. doi: 10.1007/s12020-021-02861-4..
Keywords: Diabetes, Medication, Shared Decision Making, Patient-Centered Healthcare, Clinician-Patient Communication, Chronic Conditions
Staiger B
Disruptions to the patient-provider relationship and patient utilization and outcomes: evidence from Medicaid managed care.
The patient-provider relationship is considered a cornerstone to delivering high-value healthcare. However, in Medicaid managed care settings, disruptions to this relationship are disproportionately common. In this paper, the researcher evaluated the impact of a primary provider's exit from a Medicaid managed care plan on adult beneficiary healthcare utilization and outcomes.
AHRQ-funded; HS026128.
Citation: Staiger B .
Disruptions to the patient-provider relationship and patient utilization and outcomes: evidence from Medicaid managed care.
J Health Econ 2022 Jan;81:102574. doi: 10.1016/j.jhealeco.2021.102574..
Keywords: Medicaid, Clinician-Patient Communication, Healthcare Delivery, Chronic Conditions
Morrone KA, Manwani D, Cabana MD
Efficient clinical counseling for sickle cell disease.
Sickle cell anemia (SCA) is a chronic illness that requires frequent health care visits for preventative management. Aims of this overview were to review challenges faced in outpatient subspecialty medicine and describe evidence-based techniques for more effective communication for patients with sickle cell anemia.
AHRQ-funded; HS025297.
Citation: Morrone KA, Manwani D, Cabana MD .
Efficient clinical counseling for sickle cell disease.
J Natl Med Assoc 2021 Aug;113(4):382-87. doi: 10.1016/j.jnma.2021.01.006..
Keywords: Sickle Cell Disease, Chronic Conditions, Clinician-Patient Communication, Communication, Patient Adherence/Compliance
Nair D, Malhotra S, Lupu D
Challenges in communication, prognostication and dialysis decision-making in the COVID-19 pandemic: implications for interdisciplinary care during crisis settings.
This paper uses case vignettes to highlight challenges in communication, prognostication, and medical decision-making that have been exacerbated by the COVD-19 pandemic for patients with kidney disease. The authors include best practice recommendations to mitigate those issues and conclude with implications for interdisciplinary models of care in crisis settings. Concerns about certain biomarkers, demographics, and medical comorbidities that can predict an increased risk for mortality among patients with COVID-19 and kidney disease are discussed, because there may be communication barriers related to physical exposure and conservation of personal protective equipment with those at-risk patients.
AHRQ-funded; HS026395.
Citation: Nair D, Malhotra S, Lupu D .
Challenges in communication, prognostication and dialysis decision-making in the COVID-19 pandemic: implications for interdisciplinary care during crisis settings.
Curr Opin Nephrol Hypertens 2021 Mar 1;30(2):190-97. doi: 10.1097/mnh.0000000000000689..
Keywords: COVID-19, Dialysis, Kidney Disease and Health, Shared Decision Making, Clinician-Patient Communication, Communication, Chronic Conditions
Fenton JJ, Jerant A, Franks P
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
This paper describes the protocol that will be used for an upcoming randomized control trial to determine the effectiveness of teaching clinicians how to advise watchful waiting when patients request low-value spinal imaging for acute low back pain. The authors will recruit 8-10 primary care and urgent care clinics in Sacramento, California. The study will last 3-6 months and during this time clinicians in the intervention group with receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain. The SPIs will instruct clinicians in a 3-step model emphasizing trust, empathic communication, and negotiation of a watchful waiting approach. The primary outcome looked for will a decreased post-intervention rate of spinal imaging among actual patients with acute back pain compared to the rate of imaging during the baseline period. Secondary outcomes will include use of targeted communication techniques during a follow-up visit with an SP.
AHRQ-funded; HS026415.
Citation: Fenton JJ, Jerant A, Franks P .
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
Trials 2021 Feb 27;22(1):167. doi: 10.1186/s13063-021-05106-x..
Keywords: Back Health and Pain, Pain, Chronic Conditions, Imaging, Diagnostic Safety and Quality, Clinician-Patient Communication, Communication
Hood-Medland EA, White AEC, Kravitz RL
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
This study looked at primary care visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience with patients taking opioids for chronic pain. The study analyzed 83 video-recorded US primary care visits at a single academic medical center in California. A total of 49 family medicine and internal resident physicians and 83 patients were filmed. The authors developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discusses. They identified 2 visit opening styles with agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda opening styles (open-ended question, patient launch, physician launch). Only 11% of visits included agenda setting and was associated with fewer surprise patient topics than visits without agenda setting.
AHRQ-funded; HS022236.
Citation: Hood-Medland EA, White AEC, Kravitz RL .
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
BMC Fam Pract 2021 Jan 4;22(1):4. doi: 10.1186/s12875-020-01317-4..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Clinician-Patient Communication, Communication, Ambulatory Care and Surgery
Hadler RA, Curtis BR, Ikejiani DZ
"I'd have to basically be on my deathbed": heart failure patients' perceptions of and preferences for palliative care.
This cohort study examined individuals with New York Heart Association Class II-IV disease attitude towards palliative care (PC). Participants were recruited from inpatient and outpatient settings at an academic quaternary care hospital. They were given semistructured interviews discussing perceptions, knowledge, and preferences regarding PC, and also barriers to to PC delivery by facilitators. They interviewed 27 adults with heart failure (mean age 63, 85% white, 63% male). Participants frequently confused PC with hospice but once corrected they expressed variable preferences for primary versus specialist services. Preferences for primary versus specialist PC were based on different factors. Although there was more understanding of PC after the interviews, triggers for initiation remained focused on late-stage disease.
AHRQ-funded; HS022989.
Citation: Hadler RA, Curtis BR, Ikejiani DZ .
"I'd have to basically be on my deathbed": heart failure patients' perceptions of and preferences for palliative care.
J Palliat Med 2020 Jul;23(7):915-21. doi: 10.1089/jpm.2019.0451..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Palliative Care, Clinician-Patient Communication, Communication, Chronic Conditions
Lafferty M, Fauer A, Wright N
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
The purpose of this study was to examine the causes and consequences of chemotherapy treatment delays and possible solutions to improve quality of care. The authors identified four primary themes from the analysis that affect delays. They suggest future investigations to examine nurses' communication practices in the context of timely chemotherapy administration since communication and documentation technologies within healthcare settings continuously evolve.
AHRQ-funded; HS024914.
Citation: Lafferty M, Fauer A, Wright N .
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
Oncol Nurs Forum 2020 Jul 1;47(4):417-27. doi: 10.1188/20.Onf.417-427..
Keywords: Treatments, Cancer, Ambulatory Care and Surgery, Quality of Care, Clinician-Patient Communication, Communication, Provider: Nurse, Provider, Nursing, Chronic Conditions
Fredericksen RJ, Fitzsimmons E, Gibbons LE
How do treatment priorities differ between patients in HIV care and their providers? A mixed-methods study.
The authors asked patients in HIV care and providers to prioritize topic areas to address during routine visits. They found that patients and providers showed high discordance in rank order priorities. Patients ranked social domains such as HIV stigma highly; a higher proportion of providers prioritized substance use domains. HIV stigma was a higher priority for patients in care fewer than 6 years, nonwhite patients, and younger patients. Patients' priorities differed between men and women, white race vs. other races, and Latinos vs. non-Latinos.
AHRQ-funded; HS022242.
Citation: Fredericksen RJ, Fitzsimmons E, Gibbons LE .
How do treatment priorities differ between patients in HIV care and their providers? A mixed-methods study.
AIDS Behav 2020 Apr;24(4):1170-80. doi: 10.1007/s10461-019-02746-8.
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Keywords: Human Immunodeficiency Virus (HIV), Chronic Conditions, Social Stigma, Clinician-Patient Communication, Care Management
Ike B, Baldwin LM, Sutton S
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
The authors assessed the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. Six rural and rural-serving primary care organizations implemented the Six Building Blocks, with assistance from practice facilitators, clinical experts, and informatics specialists. The authors found that clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management and recommended further research on patient experiences specific to practice redesign programs.
AHRQ-funded; HS023750.
Citation: Ike B, Baldwin LM, Sutton S .
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
J Am Board Fam Med 2019 Sep-Oct;32(5):715-23. doi: 10.3122/jabfm.2019.05.190027.
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Keywords: Opioids, Pain, Chronic Conditions, Primary Care: Models of Care, Primary Care, Care Management, Ambulatory Care and Surgery, Quality Improvement, Medication, Provider, Clinician-Patient Communication
Ronis SD, Kleinman LC, Stange KC
A learning loop model of collaborative decision-making in chronic illness.
In this article, the authors discuss their learning loop model, which posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that "meta-learning" from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians.
AHRQ-funded; HS024433.
Citation: Ronis SD, Kleinman LC, Stange KC .
A learning loop model of collaborative decision-making in chronic illness.
Acad Pediatr 2019 Jul;19(5):497-503. doi: 10.1016/j.acap.2019.04.006..
Keywords: Children/Adolescents, Chronic Conditions, Shared Decision Making, Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Clinician-Patient Communication, Communication
Pavlo AJ, O'Connell M, Olsen S
Missing ingredients in shared decision-making?
This article discusses the practice of shared decision making (SDM) for clinicians when making decisions in health care. This widespread practice is considered the best approach for person-centered care, but for individuals diagnosed with serious mental illness there are still many barriers to effective collaboration. The authors suggest that more emphasis needs to be placed on the doctor-patient relationship itself conducting SDM.
AHRQ-funded; HS023000.
Citation: Pavlo AJ, O'Connell M, Olsen S .
Missing ingredients in shared decision-making?
Psychiatr Q 2019 Jun;90(2):333-38. doi: 10.1007/s11126-019-9624-9..
Keywords: Chronic Conditions, Clinician-Patient Communication, Communication, Shared Decision Making, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Patient and Family Engagement
Chung CF, Wang Q, Schroeder J
Identifying and planning for individualized change: patient-provider collaboration using lightweight food diaries in healthy eating and irritable bowel syndrome.
This study examined if the use of a photo-based food diary app will help patients with irritable bowel syndrome (IBS) help gather food and symptom data to help their doctors with disease management. The investigators designed and developed Foodprint which includes a mobile and web app and pre-visit note to go to experts which communicate an individual’s expectations and questions. A control group and a group with IBS were used to determine the effectiveness of Foodprint.
AHRQ-funded; HS023654.
Citation: Chung CF, Wang Q, Schroeder J .
Identifying and planning for individualized change: patient-provider collaboration using lightweight food diaries in healthy eating and irritable bowel syndrome.
Proc ACM Interact Mob Wearable Ubiquitous Technol 2019 Mar;3(1). doi: 10.1145/3314394..
Keywords: Chronic Conditions, Clinician-Patient Communication, Communication, Digestive Disease and Health, Health Information Technology (HIT), Lifestyle Changes, Nutrition, Patient Self-Management
Egan M, Greenhawt M
Common questions in food allergy avoidance.
Allergists must be able to provide avoidance advice while suggesting age and nutritionally appropriate substitutions. This review therefore focuses on providing an understanding of identifying potential myths that may surround certain aspects of food allergy management, with a focus on redirecting misconceptions, and enhancing communications that can improve how patients live life with disease.
AHRQ-funded; HS024599.
Citation: Egan M, Greenhawt M .
Common questions in food allergy avoidance.
Ann Allergy Asthma Immunol 2018 Mar;120(3):263-71. doi: 10.1016/j.anai.2017.09.078.
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Keywords: Chronic Conditions, Nutrition, Patient and Family Engagement, Clinician-Patient Communication, Patient Self-Management
Berry ABL, Lim C, Hartzler AL
Creating conditions for patients' values to emerge in clinical conversations: perspectives of health care team members.
The researchers sought to inform the design of interventions to support conversations about patient values between patients with multiple chronic conditions and their health care providers. Their paper contributes a practice-based account of ways in which providers engage with patient values, and discusses how future work in interactive systems design might extend and enrich these engagements.
AHRQ-funded; HS022364.
Citation: Berry ABL, Lim C, Hartzler AL .
Creating conditions for patients' values to emerge in clinical conversations: perspectives of health care team members.
DIS (Des Interact Syst Conf) 2017 Jun;2017:1165-74. doi: 10.1145/3064663.3064669.
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Keywords: Chronic Conditions, Clinician-Patient Communication, Patient Self-Management, Patient and Family Engagement
Chung CF, Dew K, Cole A
Boundary negotiating artifacts in personal informatics: patient-provider collaboration with patient-generated data.
This paper examines patient expectations and current collaboration practices around patient-generated data. It finds that collaboration occurs in every stage of self- tracking and that patients and providers create boundary negotiating artifacts to support the collaboration. Building upon current practices with patient-generated data, the authors use these theories of patient and provider collaboration to analyze misunderstandings and privacy concerns.
AHRQ-funded; HS023654.
Citation: Chung CF, Dew K, Cole A .
Boundary negotiating artifacts in personal informatics: patient-provider collaboration with patient-generated data.
CSCW 2016 Feb 27:770-86. doi: 10.1145/2818048.2819926..
Keywords: Chronic Conditions, Health Information Technology (HIT), Clinician-Patient Communication, Patient Self-Management
Ratanawongsa N, Barton JL, Lyles CR
Association between clinician computer use and communication with patients in safety-net clinics.
The researchers studied associations between clinician computer use and communication with patients with diverse chronic diseases in safety-net clinics. They found that high computer use by clinicians in safety-net clinics was associated with lower patient satisfaction and observable communication differences.
AHRQ-funded; HS022561; HS022408.
Citation: Ratanawongsa N, Barton JL, Lyles CR .
Association between clinician computer use and communication with patients in safety-net clinics.
JAMA Intern Med 2016 Jan;176(1):125-8. doi: 10.1001/jamainternmed.2015.6186.
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Keywords: Clinician-Patient Communication, Communication, Chronic Conditions, Patient Experience, Electronic Health Records (EHRs), Health Information Technology (HIT)
Eschler J, Liu LS, Vizer LM
Designing asynchronous communication tools for optimization of patient-clinician coordination.
The authors elicited narratives about patients' experiences and expectations for using asynchronous communication to address medical issues with their clinicians. They then presented opportunities for designing asynchronous communication tools to better facilitate understanding of and coordination around care activities between patients and clinicians.
AHRQ-funded; HS021590.
Citation: Eschler J, Liu LS, Vizer LM .
Designing asynchronous communication tools for optimization of patient-clinician coordination.
AMIA Annu Symp Proc 2015 Nov 5;2015:543-52.
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Keywords: Chronic Conditions, Health Information Technology (HIT), Patient Experience, Clinician-Patient Communication, Web-Based
O'Leary K, Vizer L, Eschler J
Understanding patients' health and technology attitudes for tailoring self-management interventions.
The researchers elicited attitudes toward technology use and participation in care of 40 participants in a maximum variation sample. They found three participant clusters-"Proactive Techies," "Indie Self-Managers," and "Remind Me! Non-Techies"-that represent varying attitudes toward health behaviors and technologies that were independent of race, education level, and age. Their approach provides insight into how people prioritize important values related to health participation and technology.
AHRQ-funded; HS021590.
Citation: O'Leary K, Vizer L, Eschler J .
Understanding patients' health and technology attitudes for tailoring self-management interventions.
AMIA Annu Symp Proc 2015 Nov 5;2015:991-1000.
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Keywords: Chronic Conditions, Health Information Technology (HIT), Patient and Family Engagement, Clinician-Patient Communication
Ritholz MD, Wolpert H, Beste M
Patient-provider relationships across the transition from pediatric to adult diabetes care: a qualitative study.
The purpose of this study was to explore perceptions that emerging adults with type 1 diabetes (T1D) have of their patient-provider relationships across the transition from pediatric to adult care. Several themes emerged from the analysis including the importance of improving provider approaches to transition. Patients recommended that pediatric providers actively promote emerging adults’ autonomy while maintaining parental support.
AHRQ-funded; HS000063.
Citation: Ritholz MD, Wolpert H, Beste M .
Patient-provider relationships across the transition from pediatric to adult diabetes care: a qualitative study.
Diabetes Educ 2014 Jan-Feb;40(1):40-7. doi: 10.1177/0145721713513177..
Keywords: Chronic Conditions, Diabetes, Patient Experience, Clinician-Patient Communication, Transitions of Care