title: Attaining minimally disruptive medicine: context, challenges and a roadmap for implementation.
abstract: In this second of two papers on minimally disruptive medicine, we use the language of patient workload and patient capacity from the Cumulative Complexity Model to accomplish three tasks. First, we outline the current context in healthcare, comprised of contrasting problems: some people lack access to care and others receive too much care in an overmedicalised system, both of which reflect imbalances between patients' workloads and their capacity. Second, we identify and address five tensions and challenges between minimally disruptive medicine, the existing context, and other approaches to accessible and patient-centred care such as evidence-based medicine and greater patient engagement. Third, we outline a roadmap of three strategies toward implementing minimally disruptive medicine in practice, including large-scale paradigm shifts, mid-level add-ons to existing reform efforts, and a modular strategy using an existing 'toolkit' that is more limited in scope, but can fit into existing healthcare systems.
authors.affiliation: ND Shippee, Division of Health Policy and Management, School of Public Health, University of Minnesota, D375 Mayo MMC 729, Minneapolis, MN 55455, USA. Email nshippee@umn.edu.
authors.forename: N D
authors.initials: ND
authors.lastname: Shippee
authors.forename: S V
authors.initials: SV
authors.lastname: Allen
authors.forename: A L
authors.initials: AL
authors.lastname: Leppin
authors.forename: C R
authors.initials: CR
authors.lastname: May
authors.forename: V M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D015897:Comorbidity; D003695:Delivery of Health Care / Q000458:organization & administration*; D019468:Disease Management; D019317:Evidence-Based Medicine; D006801:Humans; D008962:Models, Theoretical; D018802:Patient-Centered Care; D012648:Self Care; D016526:Workload
keywords: Cumulative Complexity Model; evidence-based medicine; minimally disruptive medicine; multimorbidity; overmedicalisation; patient engagement