title: Clinical questions raised by providers in the care of older adults: a prospective observational study.
abstract: OBJECTIVE
  To characterise clinical questions raised by providers in the care of complex older adults in order to guide the design of interventions that can help providers answer these questions.
  
  
  METHODS
  To elicit clinical questions, we observed and audio recorded outpatient visits at three healthcare organisations. At the end of each appointment, providers were asked to identify clinical questions raised in the visit. Providers rated their questions based on their urgency, importance to the patient's care and difficulty in finding a useful answer to. Transcripts of the audio recordings were analysed to identify ageing-specific factors that may have contributed to the nature of the questions.
  
  
  RESULTS
  We observed 36 patient visits with 10 providers at the three study sites. Providers raised 70 clinical questions (median of 2 clinical questions per patient seen; range 0-12), pursued 50 (71%) and successfully answered 34 (68%) of the questions they pursued. Overall, 36 (51%) of providers' questions were not answered. Over one-third of the questions were about treatment alternatives and adverse effects. All but two clinical questions were motivated either directly or indirectly by issues related to ageing, such as the normal physiological changes of ageing and diseases with higher prevalence in the elderly.
  
  
  CONCLUSIONS
  The frequency of clinical questions was higher than in previous studies conducted in general primary care patient populations. Clinical questions were predominantly influenced by ageing-related issues. We propose a series of recommendations that may be used to guide the design of solutions to help providers answer their clinical questions in the care of older adults.
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Del Fiol
authors.affiliation: Spencer S. Eccles Health Sciences Library, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Alice I
authors.initials: AI
authors.lastname: Weber
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA Intermountain Healthcare, Salt Lake City, Utah, USA.
authors.forename: Cherie P
authors.initials: CP
authors.lastname: Brunker
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA VA Medical Center, Salt Lake City, Utah, USA.
authors.forename: Charlene R
authors.initials: CR
authors.lastname: Weir
mesh_terms: D000368:Aged; D006282:Health Personnel; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D011446:Prospective Studies; D058996:Quality Improvement; D011795:Surveys and Questionnaires
keywords: Decision-making; complex patient; delivery of health care; frail elderly