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Clinical Uncertainty at the Intersection of Advancing Technology, Evidence-Based Medicine, and Health Care Policy

Andrew J. Schoenfeld, MD, MSc1; Mitchel B. Harris, MD2; Matthew Davis, MD, MAPP1
[+] Author Affiliations
1Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor
2Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
JAMA Surg. 2014;149(12):1221-1222. doi:10.1001/jamasurg.2014.382.
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Physicians are regularly challenged to make treatment recommendations for patients whose diagnosis and prognosis are uncertain and for whom the highest-quality evidence is inconclusive. Consequently, physicians are generally accustomed to functioning in the fog of uncertainty. Until now, the dynamics of clinical decisions in the midst of uncertainty have been left to physicians to manage in partnership with their patients.

This is about to change, however, under stipulations of the Affordable Care Act (ACA). Even as uncertainty persists, the ACA will exert pressure to measure quality in uniform ways that make winners and losers based on physicians’ different practice approaches. Nonetheless, to say that some physicians will be winners does not imply that patients will also win, particularly if newly established quality measures favor practice approaches that are ultimately proven inferior, with respect to patients’ outcomes.

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Figure.
Algorithms for Establishing Quality Measures

Parallel algorithms for establishing quality measures in general and in the specific instance of cervical spine clearance. MDCT indicates multidetector computed tomography and MRI, magnetic resonance imaging.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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