When there is too much to do

Abstract

BACKGROUND: Recent evidence suggests that patients are receiving only 50% of recommended processes of care. It is important to understand physician priorities among recommended interventions and how these priorities are influenced both intentionally as well as unintentionally.

Why system inertia makes health reform so difficult

“…Clinical encounters are constrained by time and uncertain or absent data, 12 and clinicians juggle multiple problems, prioritising some over others. 13 For example, the decision to increase hypertensive therapy for a patient with high blood pressure might be delayed if the clinician thinks other clinical priorities must be dealt with first. Competing demands have been found to influence management in diabetes, mammography, depression, and smoking cessation.…”

Improving Diabetes Care by Combating Clinical Inertia

“…Third, placing excessive emphasis on glucose control may have the unintended consequence of diverting attention from other diabetes quality measures that may be equally or more important from the clinical and population health point of view, such as BP and LDL control (O'Connor 2003c; Hofer et al 2004). Fortunately, measures of clinical inertia have already been proposed for BP and LDL control (Berlowitz et al 2003).…”

“…In 2005, the HEDIS comprehensive diabetes measure still do not include BP control, but continue to include measures of eye exams and nephropathy screening (HEDIS 1995, 2000, 2005). While early detection of eye and kidney problems is not unimportant, it is possible that continued emphasis on screening for these factors may have the unintended consequence of diverting resources and attention from the clinically more productive tasks of achieving and maintaining better control of HbA1c, BP, and LDL levels (Marshall et al 2000; Sperl‐Hillen et al 2000; Hofer, Zemencuk, and Hayward 2004). …”

Pre-Visit Prioritization for complex patients with diabetes: Randomized trial design and implementation within an integrated health care system

“…These 5 domains were defined based on patient and provider interviews and informed by previously published literature. 31–33 A link in the message sends them to a survey form within the patient portal where they choose their 1 or 2 top priorities to discuss at their upcoming visit. Patients can also add free text explanation after making their choices.…”