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E/M Medical Decision Making

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1. E/M Medical Decision Making

E/M Medical Decision Making E/M Medical Decision Making Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 E/M Medical Decision Making E (...) /M Medical Decision Making Aka: E/M Medical Decision Making , E/M Straightforward Medical Decision , E/M Low Complexity Medical Decision , E/M Moderate Complexity Medical Decision , E/M High Complexity Medical Decision II. Decision Making Type: Straightforward Criteria Minimal number of diagnoses or management options Minimal or no data to be reviewed Minimal risk of complications, morbidity, mortality Related Codes III. Decision Making Type: Low Complexity Criteria Limited number of diagnoses

2018 FP Notebook

2. Decision-making capacity of detainees in immigration removal centres (IRCs)

(the ‘Tavistock Report’) found that ‘Home Office staff, who are not medically qualified, are required to make to make extremely difficult decisions’, adding that the ‘Home Office accepts that it has not always got decisions right on the detention of those with mental health conditions’. The Report also highlighted system-wide issues insofar as ‘a complex casework process […] results in the processes not being robust enough for the consideration of mental health issues at key decision points’ (Lawlor et al (...) , 2015: points 1.5, 1.6 and 4.10). 2 One case was set aside by consent.6 http://www.rcpsych.ac.uk Position Statement PS03/17 Assessment of decision-making capacity The Home Office does not currently keep records of the frequency or outcome of capacity assessments in IRCs, so the full extent of this problem is unknown. Assessment of decision-making capacity is not a routine part of the initial or subsequent medical assessments conducted in IRCs. The report of the Shaw review into the welfare

2018 Royal College of Psychiatrists

3. Supporting Parents in Making Informed Decisions in Relation to their Children?s Health Needs

. Maguire E, Hong P, Ritchie K, Meier J, Archibald K, Chorney J. Decision aid prototype development for parents considering adenotonsillectomy for their children with sleep disordered breathing. Journal Otolaryngological Head and Neck Surgery 2016; 45(1): 57. 7. Wyatt KD, List B, Brinkman WB, et al. Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis. Academic Pediatrics 2015; 15(6): 573-83. 8. Neill S, Roland D, Jones CH, Thompson M, Lakhanpaul M. Information resources to aid (...) a reduction in decisional conflict from parents, and that the combined use of decision aids and coaching supported shared decision- making.(20) The second primary study examined the use of medication choice cards to support parent decision-making.(21) The study found that clinicians using the cards reported positive experiences, but that reliable implementation and use of the decision aids was difficult, having only been implemented in 35% of visits where starting or switching medication was discussed.(21

2018 McMaster Health Forum

4. Understanding Health-Systems? Use of and Need for Evidence To Inform Decision making

their decisionmaking. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report is made available to the public under the terms of a licensing agreement between the authors (...) Understanding Health-Systems? Use of and Need for Evidence To Inform Decision making White Paper Understanding Health -Systems’ Use of and Need for Evidence To Inform Decisionmaking Research White Paper Understanding Health -Systems’ Use of and Need for Evidence To Inform Decisionmaking Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-0012-I and 290-2015-00004-I Prepared

2017 Effective Health Care Program (AHRQ)

5. Hospital Formularies Decision-Making Process

Hospital Formularies Decision-Making Process Hospital Formularies Decision-Making Process | CADTH.ca Find the information you need Hospital Formularies Decision-Making Process Hospital Formularies Decision-Making Process Published on: March 16, 2015 Project Number: ES0290 Product Line: Issue: 47 Result type: Report Context In Canada, hospital-based Pharmacy and Therapeutics Committees may function at an individual hospital level, district or regional health authority level, or provincial level (...) assurance representatives and members of the public. 1 Formulary decisions are made on the basis of empirical evidence; however, factors such as safety of similar available agents, direct costs, cost offsets, and the total cost of care with a new drug compared with current care may also significantly impact formulary decisions. 2 CADTH provides recommendations to the federal, provincial, and territorial public drug plans (hereafter the "public drug plans") to support their formulary decision-making

2016 Canadian Agency for Drugs and Technologies in Health - Environmental Scanning

6. A Framework for Evaluating a Minor’s Involvement in Medical Decision Making (PubMed)

A Framework for Evaluating a Minor’s Involvement in Medical Decision Making 29466124 2019 02 21 2019 02 21 1536-0075 18 3 2018 03 The American journal of bioethics : AJOB Am J Bioeth A Framework for Evaluating a Minor's Involvement in Medical Decision Making. 10-12 10.1080/15265161.2017.1418938 Snyder Donna L DL a Food and Drug Administration. Nelson Robert M RM a Food and Drug Administration. eng FD999999 ImFDA Intramural FDA HHS United States Journal Article Comment United States Am J (...) Bioeth 100898738 1526-5161 E IM Am J Bioeth. 2018 Mar;18(3):4-9 29466136 Abortion, Induced Child Clinical Decision-Making Humans Minors 2018 2 22 6 0 2018 2 22 6 0 2019 2 23 6 0 ppublish 29466124 10.1080/15265161.2017.1418938 PMC5997482 NIHMS971519 Pediatrics. 1995 Feb;95(2):314-7 7838658 Pediatrics. 2016 Aug;138(2):null 27456510 Am J Bioeth. 2018 Mar;18(3):4-9 29466136

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2018 The American journal of bioethics : AJOB

7. HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma

HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma CAP Laboratory Improvement Programs HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma Guideline From the College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology Angela N. Bartley, MD; Mary Kay Washington, MD, PhD; Christina B. Ventura, MT(ASCP); Nofisat Ismaila, MD; Carol Colasacco, MLIS, SCT(ASCP); Al B. Benson III, MD; Alfredo (...) . Objectives.—To establish an evidence-based guideline for HER2 testing in patients with GEA, to formalize the algorithms for methods to improve the accuracy of HER2 testing while addressing which patients and tumor speci- mens are appropriate, and to provide guidance on clinical decision making. Design.—The College of American Pathologists, Amer- ican Society for Clinical Pathology, and American Society of Clinical Oncology convened an expert panel to conduct a systematic review of the literature

2016 College of American Pathologists

8. Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision-Making for Early-Stage, Operable Breast Cancer

rigor, and an ASCO panel of content experts reviewed the content of the recommendations. CCO Recommendations For making decisions regarding adjuvant therapy, nodal status, tumor size, estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2) status, tumor grade, and lymphovascular invasion are relevant; Onco type DX score and Adjuvant! Online may be used as risk stratification tools; and age, menopausal status, and medical comorbidities should be considered (...) Female patients who are being considered for, or who are receiving, systemic therapy for early-stage invasive breast cancer (stages I to IIA, T1N0-1, T2N0). Target Audience Medical oncologists, pathologists, surgeons, oncology nurses, patients, and caregivers. Cancer Care Ontario Guideline Recommendations For making adjuvant therapy decisions for women with early-stage breast cancer, the Cancer Care Ontario guideline recommends that lymph node status, T stage, estrogen receptor (ER) status

2016 American Society of Clinical Oncology Guidelines

9. HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma

HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and the American Society of Clinical Oncology"/> HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and the American Society (...) of Clinical Oncology | Journal of Clinical Oncology Search in: Menu Article Tools ASCO SPECIAL ARTICLE Article Tools OPTIONS & TOOLS COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2016.69.4836 Journal of Clinical Oncology - published online before print November 14, 2016 PMID: HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and the American Society

2016 American Society of Clinical Oncology Guidelines

10. Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study). (PubMed)

Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study). Medication related harm (MRH) is a common cause of morbidity and hospital admission in the elderly, and has significant cost implications for both primary and secondary healthcare resources. The development of risk prediction models has become an increasingly common phenomenon in medicine and can be useful to guide (...) objective clinical decision making, resource allocation and intervention. There are no risk prediction models that are widely used in clinical practice to identify elderly patients at high risk of MRH following hospital discharge. The aim of this study is to develop a risk prediction model (RPM) to identify elderly patients at high risk of MRH upon discharge from hospital, and to compare this with routine clinical judgment.This is a multi-centre, prospective observational study following a cohort

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2016 BMC Geriatrics

11. Multi-criteria decision analysis for the appraisal of medical needs: a pilot study

? REFERENCES 126 KCE Report 272 Multi-criteria decision analysis for the appraisal of medical needs 3 LIST OF FIGURES Figure 1 – Standard reimbursement decision procedure 7 Figure 2 – Early temporary reimbursement process 9 Figure 3 – Criteria and conditions for reimbursement identified by the citizen panel 19 Figure 4 – Steps to be taken in the development of an MCDA framework 20 Figure 5 – MCDA process in decision making 21 Figure 6 – MCDA process applied in Colombia 25 Figure 7 – Patient clusters 34 (...) needs. Therefore, the CAIT / CATT assesses whether the product targets an unmet medical need, based on the list of unmet medical needs defined by the General Council of the RIZIV / INAMI. It also makes an appraisal of the usual criteria used by the Drug Reimbursement Committee during the regular procedure: the products’ added value, its cost-effectiveness, its price, its budget impact, its place in daily clinical practice. d The cohort decisions of the College of Medical Directors specify

2016 Belgian Health Care Knowledge Centre

12. Rammya Mathew: Acknowledging clinician bias in shared decision making

decision between patient and doctor. In practice this might involve the use of shared decision aids, employing the use of multidisciplinary decision-making in patients with complex multimorbidity , and most of all, keeping the person in mind rather than treating single diseases based solely on clinical guidelines which often fail to take account of the wider bio-psychosocial model. [2] Rammya Mathew is a GP at Wembley Park Drive Medical Centre and Quality Improvement Clinical Lead, Islington Federation (...) Rammya Mathew: Acknowledging clinician bias in shared decision making Rammya Mathew: Acknowledging clinician bias in shared decision making - The BMJ ---> A piece of improvement work I’ve been involved in has thrown up some questions for me around anticoagulation in atrial fibrillation (AF). indicates that we are undertreating people with AF in terms of anticoagulation, and as a result, they are unnecessarily being put at risk of having a stroke. [1] Looking at this in more detail, it seems

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2018 The BMJ Blog

13. A qualitative study of decision-making and safety in ambulance service transitions

A qualitative study of decision-making and safety in ambulance service transitions A qualitative study of decision-making and safety in ambulance service transitions A qualitative study of decision-making and safety in ambulance service transitions O'Hara R, Johnson M, Hirst E, Weyman A, Shaw D, Mortimer P, Newman C, Storey M, Turner J, Mason S, Quinn T, Shewan J, Siriwardena N Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA (...) . No evaluation of the quality of this assessment has been made for the HTA database. Citation O'Hara R, Johnson M, Hirst E, Weyman A, Shaw D, Mortimer P, Newman C, Storey M, Turner J, Mason S, Quinn T, Shewan J, Siriwardena N. A qualitative study of decision-making and safety in ambulance service transitions. Health Services and Delivery Research 2014; 2(56) Authors' objectives The aim of this study was to qualitatively examine potential system-wide influences on decision-making in the ambulance service

2015 Health Technology Assessment (HTA) Database.

14. E/M Medical Decision Making

E/M Medical Decision Making E/M Medical Decision Making Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 E/M Medical Decision Making E (...) /M Medical Decision Making Aka: E/M Medical Decision Making , E/M Straightforward Medical Decision , E/M Low Complexity Medical Decision , E/M Moderate Complexity Medical Decision , E/M High Complexity Medical Decision II. Decision Making Type: Straightforward Criteria Minimal number of diagnoses or management options Minimal or no data to be reviewed Minimal risk of complications, morbidity, mortality Related Codes III. Decision Making Type: Low Complexity Criteria Limited number of diagnoses

2015 FP Notebook

15. Don’t throw the E&M baby out with the bath water: the proposed CMS changes

, physicians often must document information that is not pertinent to the visit but must be present to choose the code, such as examining and documenting a detailed examination with at least 12 bullets from any organ system to bill a 99203. Instead, what CMS is proposing is that a physician may pick the E&M code based on the current system, the amount of time spent with the patient, or solely based on medical decision-making (MDM) guidelines for the code. The option to choose time would change (...) in that it would be based completely on total face-to-face time with the patient and not limited to visits where over 50 percent of the visit is counseling and/or coordination of care as it is at present. As an example of using MDM as the sole factor, if you have a patient with type II diabetes, hypertension, and hyperlipidemia, you review their pertinent history, review their recent labs, and advise them to continue their medications, you have moderate complexity medical decision-making and can choose 99214

2018 KevinMD blog

16. End of Life Decision Making

be made to understand and respect the cultural mores of the patient and her family. Cultural issues may include with whom one communicates within the family, whom the patient looks to for advice and decision making, how the patient feels about the use of pain medications, and how suffering is understood ( ). When a patient lacks the capacity to make health care decisions, the health care provider may be faced with conflicts between surrogate decision makers and cultural expectations. For example (...) Care Planning Since 1991, Medicaid-participating and Medicare-participating health care institutions have been required to inform all adult patients of their rights to make decisions concerning medical care, including the right to formulate an advance directive. The obstetrician–gynecologist is in an ideal position to have ongoing discussions with healthy patients about their values and wishes regarding future care and to encourage them to complete an advance directive for health care by describing

2015 American College of Obstetricians and Gynecologists

17. AUA White Paper on Implementation of Shared Decision Making into Urological Practice

Foundation Website. 2013. http://www.health.org.uk/public/cms/75/76/313/4174/Implementing%20shared%20decision%20making.pdf. 2-3-2015 Wennberg, J. E. Unwarranted variations in healthcare delivery: implications for academic medical centres . BMJ . 2002; 325 : 961 O'Connor, A. M., Llewellyn-Thomas, H. A., and Flood, A. B. Modifying unwarranted variations in health care: shared decision making using patient decision aids . Health Aff (Millwood) . 2004; Suppl Variation : VAR63 Stacey, D., Legare, F., Col, N (...) . F. et al. Decision aids for people facing health treatment or screening decisions . Cochrane Database Syst Rev . 2014 1 : CD001431 Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press, 2001 Makoul, G. and Clayman, M. L. An integrative model of shared decision making in medical encounters . Patient Educ Couns . 2006; 60 : 301 Charles, C., Gafni, A., and Whelan, T. Shared decision-making in the medical encounter

2015 American Urological Association

18. Making Immunization Decisions for School-aged Children: A Rapid Review

studies (two [-] and one [++] found that a range of perceived risks of immunization may influence some parental decisions to delay or avoid immunizations for their children. ? 1 study [-] found concerns around fear of vaccines being contraindicated for existing medical conditions 48 ? 3 studies ([-], [+], [++]) found concerns about combined antigens putting too much stress on a baby's immune system ? 4 studies (three [-], one [+]) found that when parents are making the decision to immunize (...) Making Immunization Decisions for School-aged Children: A Rapid Review 2 Making immunization decisions for school-aged children: A Rapid Review Anita Tsang-Sit, Analyst, Research and Policy Paulette Whyte, Supervisor Loretta Rowan, Manager August 25, 2014 i Table of Contents Key Messages 2 Executive Summary 3 1 Issue 6 2 Context 7 3 Conceptual Framework 9 4 Literature Review Question 10 5 Literature Search 10 6 Relevance Assessment 11 7 Results of the Search 12 8 Critical Appraisal 12 9

2014 Peel Health Library

19. “What matters most to you?” How decision aids help patients make better choices

and that research is needed on interventions that support shared decision-making between women considering mode of birth in a pregnancy after a caesarean birth and their care providers. (1) Horey D, Kealy M, Davey MA, Small R, Crowther CA. Interventions for supporting pregnant women’s decision-making about mode of birth after a caesarean. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD010041. DOI: 10.1002/14651858.CD010041.pub2. (2) Elwyn G, Frosch D, Volandes A, Edwards A, Montori V (...) . Investing in deliberation: a definition and classification of decision support interventions for people facing difficult health decisions. Medical Decision Making 2010;30:701-11. Dell Horey / February 12, 2014 Thanks very much for taking the time to write about your review here – it’s really interesting. It would be great to hear from anyone who has used one themselves, either as a health practitioner or as a patient faced with a choice. I hope we see more high quality research in this area

2014 Evidently Cochrane

20. How Returning Aggregate Research Results Impacts Interest in Research Engagement and Planned Actions Relevant to Health Care Decision Making: Cohort Study. (PubMed)

a "virtuous cycle" of research engagement, especially where ARRs are experienced favorably and affect plans to share and discuss ARRs in support of a child's chronic disease care and treatment. Reactions to ARRs vary with education level, underscoring the need for attention to equity for this model.©Elissa R Weitzman, Kara M Magane, Lauren E Wisk. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.12.2018. (...) How Returning Aggregate Research Results Impacts Interest in Research Engagement and Planned Actions Relevant to Health Care Decision Making: Cohort Study. Collection of patient-reported outcomes measures (PROs) may augment clinical data and inform health research, improving care, yet approaches to sustaining interest among patient cohorts in research participation are needed. One approach may involve returning aggregate research results (ARRs), which may help patients contextualize personal

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2018 Journal of medical Internet research

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