Skip to Main Content
 

Global Search Box

 
 
 
 

Files

File List


Lamb_Thesis_20180214 v1.pdf (2.96 MB)

ETD Abstract Container

Abstract Header

STILL CROSSING THE QUALITY CHASM: A MIXED-METHODS STUDY OF PHYSICIAN DECISION-MAKING WHEN TREATING CHRONIC DISEASES

Lamb, Christopher C
http://orcid.org/0000-0003-3398-6382
http://rave.ohiolink.edu/etdc/view?acc_num=case1519222095020285

Abstract Details

2018, Doctor of Philosophy, Case Western Reserve University, Management.
Overall healthcare spending in the U.S. is in the trillions and more than 15% of GDP, yet outcomes rank below the top 25 in most quality categories when compared to other OECD countries. The majority of spending is directed toward small patient populations with chronic diseases. Within the context of access to insurance coverage and a certain level of health literacy, experts believe increased patient–physician shared decision making (SDM) should result in better care and lower cost. However, the study of the physician’s role in facilitating SDM is limited. By understanding what factors predict when physicians will implement SDM during the treatment of specific chronic diseases, we can begin to understand the dynamics that most influence behaviors and offer recommendations to improve certain aspects of healthcare in the United States. A sequence of three studies was completed by interviewing or surveying 369 physicians who treat hemophilia and primary immune deficiency (PID). The study used dual process theory to explain the relationship between patient-centered care and SDM within a wider framework of power balance, patient/physician traits, and organizational context. These studies were supplemented by an analysis of 1) survey of 33,162 individuals across theU.S.; 2) 25 million hospitalization records from New York State comparing two (2) five-year periods; and 3) data from 200 million individual-level, de-identified enrollment data and health insurance claims across a continuum of care (both inpatient and outpatient). The first study qualitatively explored decision making between hemophilia physicians in the U.S. and U.K. and found U.S. physicians to be more patient-centric and less rule-based. The second study quantitatively tested the relationship between slow/rational vs. fast/intuitive decision making by U.S. physicians treating PID and SDM as mediated by patient-centric care; results showed a statistically significant relationship between slow/rational decision making and SDM. The third study analyzed decision-making by U.S. immunologists when treating PID and found a stronger association between rational/slow decision-making, patient-centered care, and SDM but the process is bounded by anchoring bias, power balanced by health literacy alignment, and organizational context related to time and coordination. Overall, results show that rational/slow decision making as predicted by dual process theory is important to achieve SDM for patients with complex (i.e., multiple comorbidities) chronic diseases. However, the impact of health literacy, trust, and reimbursement is much different than what is reported in the literature. In addition, the study found evidence that information is anchored or framed in a way that both biases and “nudges” patients as predicted by behavioral economists. A new integrated SDM model is put forth as a result of this research. Combining the physician survey/interview data with an analysis of individual surveys, hospitalization data, and insurance claims demonstrates a significant opportunity to improve the quality of care in the U.S. through better decision making.
Kalle Lyytinen, Ph.D (Committee Chair)
Adrian Wolfberg, Ph.D (Committee Member)
Yunmei Wang, Ph.D (Committee Member)
J. B. Silvers, Ph.D (Committee Member)
189 p.
Health Care
physician decision making; shared decision making; dual process theory; bounded shared decision making; patient alignment; primary immunodeficiency; hemophilia; patient-centric approach; bias; decision theory; patient participation; physician perspective

Recommended Citations

Citations

  • Lamb, C. C. (2018). STILL CROSSING THE QUALITY CHASM: A MIXED-METHODS STUDY OF PHYSICIAN DECISION-MAKING WHEN TREATING CHRONIC DISEASES [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1519222095020285

    APA Style (7th edition)

  • Lamb, Christopher. STILL CROSSING THE QUALITY CHASM: A MIXED-METHODS STUDY OF PHYSICIAN DECISION-MAKING WHEN TREATING CHRONIC DISEASES. 2018. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1519222095020285.

    MLA Style (8th edition)

  • Lamb, Christopher. "STILL CROSSING THE QUALITY CHASM: A MIXED-METHODS STUDY OF PHYSICIAN DECISION-MAKING WHEN TREATING CHRONIC DISEASES." Doctoral dissertation, Case Western Reserve University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=case1519222095020285

    Chicago Manual of Style (17th edition)

case1519222095020285
760
© 2018, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.