Medical Decision Making

How health professionals and patients make treatment decisions, and the barriers to, and facilitators of, effective decision making.

Surgical Site Infection and Colorectal Surgical Procedures: A Prospective Analysis of Risk Factors

Jun. 10, 2017

E. Carter Paulson, Earl Thompson, Najjia Mahmoud

In Surgical Infections, Paulson and colleagues identify risk factors for surgical site infections in patients undergoing elective colorectal surgery. They analyzed data prospectively collected as part of a randomized, blinded trial of skin anti-sepsis, using photodocumentation, patient questionnaires, and blinded review by an attending surgeon to identify infections within 30 days of discharge. From 2011 to 2015, 787 patients undergoing colorectal surgery were analyzed, with an overall infection rate of 21.5%. Four variables--incision length, surgical indication, body mass index,...

Discriminative Accuracy of Physician and Nurse Predictions for Survival and Functional Outcomes 6 Months After an ICU Admission

May. 22, 2017

Michael E. Detsky, Michael O. Harhay, Dominique F. Bayard, Aaron M. Delman, Anna E. Buehler, Saida A. Kent, Isabella V. Ciuffetelli, Elizabeth Cooney, Nicole B. Gabler, Sarah J. Ratcliffe, Mark E. Mikkelsen, Scott D. Halpern 

In JAMA, Michael Detsky and colleagues, including Michael Harhay and Scott Halpern, examine the accuracy of intensive care unit (ICU) physician and nurses’ predictions about patients’ survival and functional outcomes. Clinician predictions about a patient's chance of survival have been shown to influence decision-making for critically ill patients, yet little is known regarding their accuracy. The study was conducted in five ICUs in three hospitals in Philadelphia, and enrolled patients who spent at least three days in the ICU and required mechanical ventilation, vasopressors, or...

Effect of a Price Transparency Intervention in the Electronic Health Record on Clinician Ordering of Inpatient Laboratory Tests

Research Brief
MPatelHeadshot
May. 19, 2017

In this randomized clinical trial, clinicians did not change their ordering of inpatient lab tests when Medicare allowable fees were displayed in the electronic health record at the time of order entry.
 

Using Active Choice Within the Electronic Health Record to Increase Influenza Vaccination Rates

Apr. 1, 2017

Mitesh S. Patel, Kevin G. Volpp, Dylan S. Small, Craig Wynn, Jingsan Zhu, Lin Yang, Steven Honeywell Jr., Susan C. Day

In the Journal of General Internal Medicine, Mitesh Patel and colleagues, including Kevin Volpp ​and Dylan Small, evaluate the association between an active choice intervention in the electronic health record and changes in influenza vaccination rates. Despite the benefits of influenza vaccination, each year more than half of adults in the U.S. do not receive it. In this study, the “active choice intervention” was a best practice alert in the electronic health record system, which prompted the provider to actively “accept” or “cancel” an order for the influenza vaccine. The study...

43 Ways to Leave Your Technology

Feb. 14, 2017

We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.

The Emerging Market of Smartphone-Integrated Infant Physiologic Monitors

Jan. 27, 2017

Christopher P. Bonafide,  David T. Jamison,  Elizabeth E. Foglia, 

In a JAMA Viewpoint, Christopher Bonafide and colleagues discuss the efficacy and safety of smartphone apps integrated with sensors that monitor infants’ vital signs. While the performance characteristics of these sensors are unknown to the public and the regulations around them are scarce, their sales have skyrocketed, reaching 40,000 units for a single brand of “smart sock” monitors. These companies use direct-to-parent advertising to portray their products as necessary to alert parents when something is wrong with their infants’ cardiorespiratory health, even though there are...

A Trial of Financial and Social Incentives to Increase Older Adults’ Walking

Jan. 20, 2017


Kristin A. Harkins, Jeffrey T. Kullgren, Scarlett L. Bellamy, Jason Karlawish, Karen Glanz
 

In the American Journal of Preventive Medicine, Kristin Harkins and colleagues, including LDI Senior Fellows Jason Karlawish and Karen Glanz, investigate the effects of financial incentives and donations to charity separately and combined on older adults’ uptake and retention of increased levels of walking. Despite evidence that regular physical activity confers health benefits, physical activity rates among older adults remain low. Both personal and social goals may enhance older adults’ motivation to become active. Ninety-four participants aged ≥65 years participated in this...

Effect of a Decision Aid on Access to Total Knee Replacement for Black Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial

Research Brief
Dec. 8, 2016

An educational video on the risks and benefits of total knee replacement increased the rate of surgery among black patients, in a clinical trial of an intervention that could reduce known racial disparities in treatment of osteoarthritis.

A randomized trial of lottery-based incentives and reminders to improve warfarin adherence: the Warfarin Incentives (WIN2) Trial

Nov. 20, 2016

Stephen E. Kimmel, Andrea B. Troxel, Benjamin French, George Loewenstein, Jalpa A. Doshi, Todd E. H. Hecht, Mitchell Laskin, Colleen M. Brensinger, Chris Meussner, Kevin Volpp

In Pharmacoepidemiology and Drug Safety, Stephen Kimmel and colleagues, including Jalpa Doshi, Benjamin French and Kevin Volpp, investigate the comparative effectiveness of reminders alone versus daily lottery incentives in improving medication adherence. This study was a four-arm multi-center...

Decision-making and goal-setting in chronic disease management: baseline findings of a randomized controlled trial

Oct. 6, 2016

Shreya Kangovi, Nandita Mitra, Robyn A. Smith, Raina Kulkarni, Lindsey Turr, Hairong Huo, Karen Glanz, David Grande, Judith A. Long

In Patient Education & Counseling, Shreya Kangovi and colleagues, including Nandita Mitra, Karen Glanz, David Grande, and Judith Long, investigate decision-making in chronic disease management – whether patients are making the ‘right choices’ from a biomedical perspective, whether patients and providers are setting goals of appropriate difficulty, and what types of support the patients will need to accomplish their goals. The authors analyzed goals and action plans from a trial of collaborative goal-setting that used a literacy aid with 302 residents of a high-poverty urban...

Pennsylvania Launches its Prescription Drug Monitoring Program

Aug. 25, 2016

Prescribers are drawing a lot of attention as a key target of initiatives to combat the opioid crisis. This week, the US Surgeon General, Vivek Murthy, took the unprecedented step of sending 2.3 million clinicians a letter calling for a national movement to turn the tide on the opioid crisis.

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