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来源类型Publication
Barriers to and Facilitators of Evidence-Based Decision Making at the Point of Care: Implications for Delivery Systems, Payers, and Policy Makers
Ann S. O’Malley; Anna Collins; Kara Contreary; and Eugene C. Rich
发表日期2016-07-25
出版者MDM Policy and Practice, vol. 1, no. 1
出版年2016
语种英语
概述The authors examined physicians’ perspectives on factors that support or hinder evidence-based decisions and the implications for delivery systems, payers, and policymakers.",
摘要

Introduction: Physicians vary widely in how they treat some health conditions, despite strong evidence favoring certain treatments over others. We examined physicians’ perspectives on factors that support or hinder evidence-based decisions and the implications for delivery systems, payers, and policymakers.

Methods: We used Choosing Wisely® recommendations to create four clinical vignettes for common types of decisions. We conducted semi-structured interviews with 36 specialists to identify factors that support or hinder evidence-based decisions. We examined these factors using a conceptual framework that includes six levels: patients, physicians, practice sites, organizations, networks and hospital affiliations, and the local market. In this model, population characteristics and payer and regulatory factors interact to influence decisions.

Results: Patient openness to behavior modification and expectations, facilitated and hindered physicians in making evidence-based recommendations. Physicians’ communication skills were the most commonly mentioned facilitator. Practice site, organization, and hospital system barriers included measures of emergency department throughput, the order in which test options are listed in electronic health records (EHR), lack of relevant decision support in EHRs, and payment incentives that maximize billing and encourage procedures rather than medical management or counseling patients on behavior change. Factors from different levels interacted to undermine evidence-based care. Most physicians received billing feedback, but quality metrics on evidence-based service use were nonexistent for the four decisions in this study.

Conclusions and Implications: Additional research and quality improvement may help to modify delivery systems to overcome barriers at multiple levels. Enhancing provider communication skills, improving decision support in EHRs, modifying workflows, and refining the design and interpretation of some quality metrics would help, particularly if combined with concurrent payment reform to realign financial incentives across stakeholders. 

URLhttps://www.mathematica.org/our-publications-and-findings/publications/barriers-to-and-facilitators-of-evidencebased-decision-making-at-the-point-of-care
来源智库Mathematica Policy Research (United States)
资源类型智库出版物
条目标识符http://119.78.100.153/handle/2XGU8XDN/488559
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Ann S. O’Malley,Anna Collins,Kara Contreary,et al. Barriers to and Facilitators of Evidence-Based Decision Making at the Point of Care: Implications for Delivery Systems, Payers, and Policy Makers. 2016.
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