Clinical Inertia and Outpatient Medical Errors

Abstract

Clinical inertia is defined as lack of treatment intensification in a patient not at evidence-based goals for care. Clinical inertia is a major factor that contributes to inadequate chronic disease care in patients with diabetes mellitus, hypertension, dyslipidemias, depression, coronary heart disease and other conditions. Recent work suggests that clinical inertia related to the management of diabetes, hypertension and lipid disorders may contribute to up to 80 percent of heart attacks and strokes. Clinical inertia is, therefore, a leading cause of potentially preventable adverse events, disability, death and excess medical care costs. This paper addresses three specific objectives: (1) to present a conceptual model of clinical inertia that takes into account recent developments in human factors research, cognitive science and organizational behavior; (2) to operationally define clinical inertia and propose simple clinical protocols that can be used to identify and map its incidence across populations of patients and physicians; and (3) to propose future research to reduce clinical inertia by specifically targeting the root causes of the problem. Ultimately, a better understanding of clinical inertia and the development of specific interventions to reduce it may be a productive strategy to reduce passive errors that contribute to hundreds of thousands of adverse events and tens of thousands of premature deaths annually in the United States.

Antihypertensive Medication Initiation Among Young Adults with Regular Primary Care Use

“…Explanatory variables statistically significant at p<0.2 in Pearson correlations 33 and based on the established conceptual model for clinical inertia were considered for inclusion in regression models. 23 The proportional hazards assumption for each model was tested using a generalized linear regression of the scaled Schoenfeld residuals on functions of time. 34 In a sensitivity analysis, regression models were repeated excluding patients with < 6 months follow-up.…”

“…However, it should be stressed that medication initiation and hypertension control were suboptimal in the middle and older age groups, supporting multiple prior studies. 1,9,23 In both models, patients with more primary care or specialty visits were more likely to be initiated on medication. These findings are supported by studies in older age groups 4,37 and highlight the importance of timely clinic follow-up for hypertension management.…”

“…Patient and provider explanatory variables to identify barriers to hypertension management, including antihypertensive initiation, were selected based on an established conceptual model for clinical inertia. 23 Patient-related factors included: sociodemographics (age, sex, marital status, Medicaid use during the baseline or study period, primary spoken language), behavioral risk factors (baseline tobacco use and body mass index at time of meeting hypertension criteria), JNC 7 stage of hypertension (Stage 1: 140-159/90-99 mmHg; Stage 2: ≥ 160/ 100 mmHg), and comorbidities. Patient comorbidities were assessed at baseline using established algorithms.…”

Outcomes and Treatment Patterns of Adding a Third Agent to 2 OADs in Patients with Type 2 Diabetes

“…12 Consequently, the transition to insulin is often delayed, 13,14 leaving patients with sustained hyperglycemia and increased risk of diabetes-related complications. [15][16][17][18][19] This study assessed 2-year treatment and persistence patterns and glycemic and economic outcomes among U.S. patients with T2DM who added a third type of antidiabetic medication (another OAD, insulin, or GLP-1).…”

Under-use of appropriate blood pressure–lowering and lipid-lowering therapy in the Busselton baby boomer population

“…18,19 It is also important to recognise that clinical inertia related to an interplay of clinician, patient and practice system factors remains a major contributor to inadequate chronic disease management; ultimately, a better understanding of clinical inertia and the development of specific interventions to reduce it is crucial. 20 Among the high-risk participants receiving recommended combination therapy, women were less likely to achieve SBP and total cholesterol targets when compared with men (28.4%, compared with 49.0%). Women attending primary healthcare services in Australia are known to be less likely than men to have CVD risk factors measured and absolute risk assessed.…”