Listening to the Patient: A Typology of Contextual Red Flags in Disease Management Encounters.

Binns-Calvey AE, Sharma G, Ashley N, Kelly B, Weaver FM, Weiner SJ. Listening to the Patient: A Typology of Contextual Red Flags in Disease Management Encounters. Journal of patient-centered research and reviews. 2020 Jan 27; 7(1):39-46.

Related HSR&D Project(s)

• EDU 08-430 – Intervening to Prevent Contextual Errors in Medical Decision Making
• RCS 98-354 – Research Career Scientist Award
• IIR 15-452 – Evaluating Use of Patient-Collected Audio Recorded Encounters for Provider Audit Feedback to Reduce Contextual Errors

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Abstract:

Purpose: Patients send clues, often unwittingly, when they are grappling with a life challenge that complicates their care. For instance, a patient may lose control of a previously well-managed chronic condition or start missing appointments. When explored, these clues help clinicians uncover the life circumstance impacting the individual's ability to manage their health and health care. Such clues are termed "contextual red flags." Effective care requires recognizing them, asking about them, and customizing the care plan where feasible. We sought to develop a typology of contextual red flags by analyzing audio recordings along with the medical records of encounters between patients and providers in outpatient clinics. Methods: During the course of 3 studies on physician attention to patient context conducted over a 5-year span (2012-2016), 4 full-time coders listened to the audios and reviewed the medical records of 2963 clinician-patient encounters. A list of contextual red flags was accrued and categorized until saturation was achieved. Results: A total of 70 contextual red flags were sorted into 9 categories, comprising a typology of contextual red flags: uncontrolled chronic conditions; appointment adherence; resource utilization; medication adherence; adherence to plan of care; significant weight loss/gain; patient knowledge of health or health care status; medical equipment/supplies adherence; other. Conclusions: A relatively small number of clues that patients are struggling to self-manage their care warrant clinicians' exploring opportunities to adapt care plans to individual life circumstances. These contextual red flags group into an even smaller set of logical categories, providing a framework to guide clinicians about when to elicit additional information from patients about life challenges they are facing.