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Copyright (c) 2024 Lujain Abduh Alamodi, Alrumaisaa Ahmad Daafi, Wejdan Saddiq Hindi, Kharifah Mohammad Ibrahem Sherah, Tariq Dohmi Ahmed Mubaraki, Khulud Abdullah Omaysh, Wasan Siddiq Alsalem, Shaima Yahya Otayf, Fatima Ahmed Majrabi, Ahmed Ali Shubayli, Ghaliya Yahya Ali Shannaq, Wedad Mohammad Alhazmi, Ebtisam Rashid Alsehly, Ibtihal Hassan Ali Hadi, Shemah Mohamed Ali Hakami

This work is licensed under a Creative Commons Attribution 4.0 International License.
Beyond the Clock: Reconciling Efficiency with Comprehensive Care in the 15-Minute Visit
Corresponding Author(s) : Lujain Abduh Alamodi
Saudi Journal of Medicine and Public Health,
Vol. 1 No. 2 (2024)
Abstract
Background: The 15-minute patient visit has become a predominant model in modern healthcare systems, driven by economic pressures, physician shortages, and rising patient volumes. This constrained timeframe presents a significant challenge to delivering comprehensive, patient-centered care, potentially compromising quality, satisfaction, and clinical outcomes. Aim: This narrative review aims to critically synthesize the evidence on strategies to maximize both efficiency and clinical effectiveness within the 15-minute primary care visit, analyzing the inherent tensions and proposing a framework for optimized practice. Methods: A comprehensive literature search was conducted across PubMed, Scopus, and PsycINFO databases (2010-2024). Studies focusing on time management, communication techniques, team-based care, technology integration, and outcome measures in brief outpatient consultations were included and thematically analyzed. Results: Evidence supports the efficacy of specific pre-visit planning, agenda setting, shared decision-making aids, effective team delegation, and integrated digital tools in enhancing visit quality. However, the review identifies persistent risks, including physician burnout, disparities in care for complex patients, and over-reliance on transactional medicine. Conclusion: Maximizing the 15-minute visit requires a multifaceted approach that extends beyond clinician speed to encompass system-level redesign, team function, and technology leverage. A "pre-visit, in-visit, post-visit" model, supported by continuous training and appropriate performance metrics, is essential to reconcile efficiency with comprehensive, effective care.
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- 1. Abbo, E. D., Zhang, Q., Zelder, M., & Huang, E. S. (2008). The increasing number of clinical items addressed during the time of adult primary care visits. Journal of general internal medicine, 23(12), 2058-2065. https://doi.org/10.1007/s11606-008-0805-8
- 2. Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W. J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations. The Annals of Family Medicine, 15(5), 419-426. https://doi.org/10.1370/afm.2121
- 3. Asare, M., Fakhoury, C., Thompson, N., Culakova, E., Kleckner, A. S., Adunlin, G., ... & Kamen, C. S. (2020). The patient–provider relationship: predictors of black/African American Cancer patients’ perceived quality of care and health outcomes. Health communication, 35(10), 1289-1294. https://doi.org/10.1080/10410236.2019.1625006
- 4. Basu, S., Phillips, R. S., Phillips, R., Peterson, L. E., & Landon, B. E. (2020). Primary Care Practice Finances In The United States Amid The COVID-19 Pandemic: Study estimates the potential impact of COVID-19 on operating expenses and revenues of primary care practices. Health Affairs, 39(9), 1605-1614. https://doi.org/10.1377/hlthaff.2020.00794
- 5. Bodenheimer, T., & Laing, B. Y. (2007). The teamlet model of primary care. The Annals of Family Medicine, 5(5), 457-461. https://doi.org/10.1370/afm.731
- 6. Bodenheimer, T. S., & Smith, M. D. (2013). Primary care: proposed solutions to the physician shortage without training more physicians. Health Affairs, 32(11), 1881-1886. https://doi.org/10.1377/hlthaff.2013.0234
- 7. Bohr, A., & Memarzadeh, K. (2020). The rise of artificial intelligence in healthcare applications. In Artificial Intelligence in healthcare (pp. 25-60). Academic Press.https://doi.org/10.1016/B978-0-12-818438-7.00002-2
- 8. Breton, M., Sullivan, E. E., Deville-Stoetzel, N., McKinstry, D., DePuccio, M., Sriharan, A., ... & McAlearney, A. S. (2021). Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts. BMC family practice, 22(1), 192. https://doi.org/10.12927/hcpol.2021.26576
- 9. Chen, J., Ou, L., & Hollis, S. J. (2013). A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC health services research, 13(1), 211. https://doi.org/10.1186/1472-6963-13-211
- 10. Dean, W., Talbot, S., & Dean, A. (2019). Reframing clinician distress: moral injury not burnout. Federal Practitioner, 36(9), 400. https://pubmed.ncbi.nlm.nih.gov/31571807/
- 11. De Vries, A. M. M., De Roten, Y., Meystre, C., Passchier, J., Despland, J. N., & Stiefel, F. (2014). Clinician characteristics, communication, and patient outcome in oncology: a systematic review. Psycho‐Oncology, 23(4), 375-381. https://doi.org/10.1002/pon.3445
- 12. Elwyn, G., Durand, M. A., Song, J., Aarts, J., Barr, P. J., Berger, Z., ... & Van der Weijden, T. (2017). A three-talk model for shared decision making: multistage consultation process. bmj, 359. https://doi.org/10.1136/bmj.j4891
- 13. Epstein, R. M., Duberstein, P. R., Fenton, J. J., Fiscella, K., Hoerger, M., Tancredi, D. J., ... & Kravitz, R. L. (2017). Effect of a patient-centered communication intervention on oncologist-patient communication, quality of life, and health care utilization in advanced cancer: the VOICE randomized clinical trial. JAMA oncology, 3(1), 92-100. doi:10.1001/jamaoncol.2016.4373
- 14. Evans, D. B., Henschen, B. L., Poncelet, A. N., Wilkerson, L., & Ogur, B. (2019). Continuity in undergraduate medical education: mission not accomplished. Journal of general internal medicine, 34(10), 2254-2259. https://doi.org/10.1007/s11606-019-04949-0
- 15. Garcia, M. E., Hinton, L., Gregorich, S. E., Livaudais-Toman, J., Kaplan, C., & Karliner, L. (2020). Unmet mental health need among Chinese and Latino primary care patients: intersection of ethnicity, gender, and English proficiency. Journal of General Internal Medicine, 35(4), 1245-1251. https://doi.org/10.1007/s11606-019-05483-9
- 16. Gidwani, R., Nguyen, C., Kofoed, A., Carragee, C., Rydel, T., Nelligan, I., ... & Lin, S. (2017). Impact of scribes on physician satisfaction, patient satisfaction, and charting efficiency: a randomized controlled trial. The Annals of Family Medicine, 15(5), 427-433. https://doi.org/10.1370/afm.2122
- 17. Grant, R. W., McCloskey, J., Hatfield, M., Uratsu, C., Ralston, J. D., Bayliss, E., & Kennedy, C. J. (2020). Use of latent class analysis and k-means clustering to identify complex patient profiles. JAMA network open, 3(12), e2029068-e2029068. doi:10.1001/jamanetworkopen.2020.29068
- 18. Irizarry, T., DeVito Dabbs, A., & Curran, C. R. (2015). Patient portals and patient engagement: a state of the science review. Journal of medical Internet research, 17(6), e148. https://doi.org/10.2196/jmir.4255
- 19. Irving, G., Neves, A. L., Dambha-Miller, H., Oishi, A., Tagashira, H., Verho, A., & Holden, J. (2017). International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ open, 7(10), e017902. https://doi.org/10.1136/bmjopen-2017-017902
- 20. Lewis, V. A., Colla, C. H., Tierney, K., Van Citters, A. D., Fisher, E. S., & Meara, E. (2014). Few ACOs pursue innovative models that integrate care for mental illness and substance abuse with primary care. Health Affairs, 33(10), 1808-1816. https://doi.org/10.1377/hlthaff.2014.0353
- 21. Meeks, D. W., Takian, A., Sittig, D. F., Singh, H., & Barber, N. (2014). Exploring the sociotechnical intersection of patient safety and electronic health record implementation. Journal of the American Medical Informatics Association, 21(e1), e28-e34.
- 22. Meyer, A. N., Giardina, T. D., Spitzmueller, C., Shahid, U., Scott, T. M., & Singh, H. (2020). Patient perspectives on the usefulness of an artificial intelligence–assisted symptom checker: cross-sectional survey study. Journal of medical Internet research, 22(1), e14679. https://doi.org/10.2196/14679
- 23. Ming, D. K., Sangkaew, S., Chanh, H. Q., Nhat, P. T., Yacoub, S., Georgiou, P., & Holmes, A. H. (2020). Continuous physiological monitoring using wearable technology to inform individual management of infectious diseases, public health and outbreak responses. International Journal of Infectious Diseases, 96, 648-654. https://doi.org/10.1016/j.ijid.2020.05.086
- 24. Noah, B., Keller, M. S., Mosadeghi, S., Stein, L., Johl, S., Delshad, S., ... & Spiegel, B. M. (2018). Impact of remote patient monitoring on clinical outcomes: an updated meta-analysis of randomized controlled trials. NPJ digital medicine, 1(1), 20172. https://doi.org/10.1038/s41746-017-0002-4
- 25. Nutting, P. A., Crabtree, B. F., Miller, W. L., Stange, K. C., Stewart, E., & Jaén, C. (2011). Transforming physician practices to patient-centered medical homes: lessons from the national demonstration project. Health affairs, 30(3), 439-445. https://doi.org/10.1377/hlthaff.2010.0159
- 26. Overhage, J. M., & McCallie Jr, D. (2020). Physician time spent using the electronic health record during outpatient encounters: a descriptive study. Annals of internal medicine, 172(3), 169-174. https://doi.org/10.7326/M18-3684
- 27. Petterson, S. M., Liaw, W. R., Phillips, R. L., Rabin, D. L., Meyers, D. S., & Bazemore, A. W. (2012). Projecting US primary care physician workforce needs: 2010-2025. The Annals of Family Medicine, 10(6), 503-509. https://doi.org/10.1370/afm.1431
- 28. Raffoul, M., Moore, M., Kamerow, D., & Bazemore, A. (2016). A primary care panel size of 2500 is neither accurate nor reasonable. The Journal of the American Board of Family Medicine, 29(4), 496-499. https://doi.org/10.3122/jabfm.2016.04.150317
- 29. Roland, M., Rao, S. R., Sibbald, B., Hann, M., Harrison, S., Walter, A., ... & Campbell, E. G. (2011). Professional values and reported behaviours of doctors in the USA and UK: quantitative survey. BMJ quality & safety, 20(6), 515-521. https://doi.org/10.1136/bmjqs.2010.048173
- 30. Shepardson, R. L., Fletcher, T. L., Funderburk, J. S., Weisberg, R. B., Beehler, G. P., & Maisto, S. A. (2023). Barriers to and facilitators of using evidence-based, cognitive–behavioral anxiety interventions in integrated primary care practice. Psychological services, 20(4), 709. https://psycnet.apa.org/doi/10.1037/ser0000696
- 31. Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., ... & Bindman, A. B. (2003). Closing the loop: physician communication with diabetic patients who have low health literacy. Archives of internal medicine, 163(1), 83-90. doi:10.1001/archinte.163.1.83
- 32. Shanafelt, T. D., Dyrbye, L. N., Sinsky, C., Hasan, O., Satele, D., Sloan, J., & West, C. P. (2016, July). Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. In Mayo clinic proceedings (Vol. 91, No. 7, pp. 836-848). Elsevier. https://doi.org/10.1016/j.mayocp.2016.05.007
- 33. Sinsky, C. A., Willard-Grace, R., Schutzbank, A. M., Sinsky, T. A., Margolius, D., & Bodenheimer, T. (2014). In search of joy in practice. A report of 23 high-functioning primary care practices, 2013, 11.
- 34. Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., ... & Blike, G. (2016). Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Annals of internal medicine, 165(11), 753-760. https://doi.org/10.7326/M16-0961
- 35. Sudore, R. L., Schillinger, D., Katen, M. T., Shi, Y., Boscardin, W. J., Osua, S., & Barnes, D. E. (2018). Engaging diverse English-and Spanish-speaking older adults in advance care planning: the PREPARE randomized clinical trial. JAMA internal medicine, 178(12), 1616-1625. doi:10.1001/jamainternmed.2018.4657
- 36. Tai-Seale, M., Olson, C. W., Li, J., Chan, A. S., Morikawa, C., Durbin, M., ... & Luft, H. S. (2017). Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine. Health affairs, 36(4), 655-662. https://doi.org/10.1377/hlthaff.2016.0811
- 37. van den Berk‐Clark, C., Doucette, E., Rottnek, F., Manard, W., Prada, M. A., Hughes, R., ... & Schneider, F. D. (2018). Do patient‐centered medical homes improve health behaviors, outcomes, and experiences of low‐income patients? A systematic review and meta‐analysis. Health Services Research, 53(3), 1777-1798. https://doi.org/10.1111/1475-6773.12737
- 38. Weiner, S. J., Schwartz, A., Weaver, F., Goldberg, J., Yudkowsky, R., Sharma, G., ... & Abrams, R. I. (2010). Contextual errors and failures in individualizing patient care: a multicenter study. Annals of Internal Medicine, 153(2), 69-75. https://doi.org/10.7326/0003-4819-153-2-201007200-00002
- 39. White, A., & Danis, M. (2013). Enhancing patient-centered communication and collaboration by using the electronic health record in the examination room. Jama, 309(22), 2327-2328. doi:10.1001/jama.2013.6030
- 40. Willard-Grace, R., Hessler, D., Rogers, E., Dubé, K., Bodenheimer, T., & Grumbach, K. (2014). Team structure and culture are associated with lower burnout in primary care. The Journal of the American Board of Family Medicine, 27(2), 229-238. https://doi.org/10.3122/jabfm.2014.02.130215
- 41. Zhou, L., DeAlmeida, D., & Parmanto, B. (2019). Applying a user-centered approach to building a mobile personal health record app: development and usability study. JMIR mHealth and uHealth, 7(7), e13194. https://doi.org/10.2196/13194
References
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2. Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W. J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations. The Annals of Family Medicine, 15(5), 419-426. https://doi.org/10.1370/afm.2121
3. Asare, M., Fakhoury, C., Thompson, N., Culakova, E., Kleckner, A. S., Adunlin, G., ... & Kamen, C. S. (2020). The patient–provider relationship: predictors of black/African American Cancer patients’ perceived quality of care and health outcomes. Health communication, 35(10), 1289-1294. https://doi.org/10.1080/10410236.2019.1625006
4. Basu, S., Phillips, R. S., Phillips, R., Peterson, L. E., & Landon, B. E. (2020). Primary Care Practice Finances In The United States Amid The COVID-19 Pandemic: Study estimates the potential impact of COVID-19 on operating expenses and revenues of primary care practices. Health Affairs, 39(9), 1605-1614. https://doi.org/10.1377/hlthaff.2020.00794
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7. Bohr, A., & Memarzadeh, K. (2020). The rise of artificial intelligence in healthcare applications. In Artificial Intelligence in healthcare (pp. 25-60). Academic Press.https://doi.org/10.1016/B978-0-12-818438-7.00002-2
8. Breton, M., Sullivan, E. E., Deville-Stoetzel, N., McKinstry, D., DePuccio, M., Sriharan, A., ... & McAlearney, A. S. (2021). Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts. BMC family practice, 22(1), 192. https://doi.org/10.12927/hcpol.2021.26576
9. Chen, J., Ou, L., & Hollis, S. J. (2013). A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC health services research, 13(1), 211. https://doi.org/10.1186/1472-6963-13-211
10. Dean, W., Talbot, S., & Dean, A. (2019). Reframing clinician distress: moral injury not burnout. Federal Practitioner, 36(9), 400. https://pubmed.ncbi.nlm.nih.gov/31571807/
11. De Vries, A. M. M., De Roten, Y., Meystre, C., Passchier, J., Despland, J. N., & Stiefel, F. (2014). Clinician characteristics, communication, and patient outcome in oncology: a systematic review. Psycho‐Oncology, 23(4), 375-381. https://doi.org/10.1002/pon.3445
12. Elwyn, G., Durand, M. A., Song, J., Aarts, J., Barr, P. J., Berger, Z., ... & Van der Weijden, T. (2017). A three-talk model for shared decision making: multistage consultation process. bmj, 359. https://doi.org/10.1136/bmj.j4891
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14. Evans, D. B., Henschen, B. L., Poncelet, A. N., Wilkerson, L., & Ogur, B. (2019). Continuity in undergraduate medical education: mission not accomplished. Journal of general internal medicine, 34(10), 2254-2259. https://doi.org/10.1007/s11606-019-04949-0
15. Garcia, M. E., Hinton, L., Gregorich, S. E., Livaudais-Toman, J., Kaplan, C., & Karliner, L. (2020). Unmet mental health need among Chinese and Latino primary care patients: intersection of ethnicity, gender, and English proficiency. Journal of General Internal Medicine, 35(4), 1245-1251. https://doi.org/10.1007/s11606-019-05483-9
16. Gidwani, R., Nguyen, C., Kofoed, A., Carragee, C., Rydel, T., Nelligan, I., ... & Lin, S. (2017). Impact of scribes on physician satisfaction, patient satisfaction, and charting efficiency: a randomized controlled trial. The Annals of Family Medicine, 15(5), 427-433. https://doi.org/10.1370/afm.2122
17. Grant, R. W., McCloskey, J., Hatfield, M., Uratsu, C., Ralston, J. D., Bayliss, E., & Kennedy, C. J. (2020). Use of latent class analysis and k-means clustering to identify complex patient profiles. JAMA network open, 3(12), e2029068-e2029068. doi:10.1001/jamanetworkopen.2020.29068
18. Irizarry, T., DeVito Dabbs, A., & Curran, C. R. (2015). Patient portals and patient engagement: a state of the science review. Journal of medical Internet research, 17(6), e148. https://doi.org/10.2196/jmir.4255
19. Irving, G., Neves, A. L., Dambha-Miller, H., Oishi, A., Tagashira, H., Verho, A., & Holden, J. (2017). International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ open, 7(10), e017902. https://doi.org/10.1136/bmjopen-2017-017902
20. Lewis, V. A., Colla, C. H., Tierney, K., Van Citters, A. D., Fisher, E. S., & Meara, E. (2014). Few ACOs pursue innovative models that integrate care for mental illness and substance abuse with primary care. Health Affairs, 33(10), 1808-1816. https://doi.org/10.1377/hlthaff.2014.0353
21. Meeks, D. W., Takian, A., Sittig, D. F., Singh, H., & Barber, N. (2014). Exploring the sociotechnical intersection of patient safety and electronic health record implementation. Journal of the American Medical Informatics Association, 21(e1), e28-e34.
22. Meyer, A. N., Giardina, T. D., Spitzmueller, C., Shahid, U., Scott, T. M., & Singh, H. (2020). Patient perspectives on the usefulness of an artificial intelligence–assisted symptom checker: cross-sectional survey study. Journal of medical Internet research, 22(1), e14679. https://doi.org/10.2196/14679
23. Ming, D. K., Sangkaew, S., Chanh, H. Q., Nhat, P. T., Yacoub, S., Georgiou, P., & Holmes, A. H. (2020). Continuous physiological monitoring using wearable technology to inform individual management of infectious diseases, public health and outbreak responses. International Journal of Infectious Diseases, 96, 648-654. https://doi.org/10.1016/j.ijid.2020.05.086
24. Noah, B., Keller, M. S., Mosadeghi, S., Stein, L., Johl, S., Delshad, S., ... & Spiegel, B. M. (2018). Impact of remote patient monitoring on clinical outcomes: an updated meta-analysis of randomized controlled trials. NPJ digital medicine, 1(1), 20172. https://doi.org/10.1038/s41746-017-0002-4
25. Nutting, P. A., Crabtree, B. F., Miller, W. L., Stange, K. C., Stewart, E., & Jaén, C. (2011). Transforming physician practices to patient-centered medical homes: lessons from the national demonstration project. Health affairs, 30(3), 439-445. https://doi.org/10.1377/hlthaff.2010.0159
26. Overhage, J. M., & McCallie Jr, D. (2020). Physician time spent using the electronic health record during outpatient encounters: a descriptive study. Annals of internal medicine, 172(3), 169-174. https://doi.org/10.7326/M18-3684
27. Petterson, S. M., Liaw, W. R., Phillips, R. L., Rabin, D. L., Meyers, D. S., & Bazemore, A. W. (2012). Projecting US primary care physician workforce needs: 2010-2025. The Annals of Family Medicine, 10(6), 503-509. https://doi.org/10.1370/afm.1431
28. Raffoul, M., Moore, M., Kamerow, D., & Bazemore, A. (2016). A primary care panel size of 2500 is neither accurate nor reasonable. The Journal of the American Board of Family Medicine, 29(4), 496-499. https://doi.org/10.3122/jabfm.2016.04.150317
29. Roland, M., Rao, S. R., Sibbald, B., Hann, M., Harrison, S., Walter, A., ... & Campbell, E. G. (2011). Professional values and reported behaviours of doctors in the USA and UK: quantitative survey. BMJ quality & safety, 20(6), 515-521. https://doi.org/10.1136/bmjqs.2010.048173
30. Shepardson, R. L., Fletcher, T. L., Funderburk, J. S., Weisberg, R. B., Beehler, G. P., & Maisto, S. A. (2023). Barriers to and facilitators of using evidence-based, cognitive–behavioral anxiety interventions in integrated primary care practice. Psychological services, 20(4), 709. https://psycnet.apa.org/doi/10.1037/ser0000696
31. Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., ... & Bindman, A. B. (2003). Closing the loop: physician communication with diabetic patients who have low health literacy. Archives of internal medicine, 163(1), 83-90. doi:10.1001/archinte.163.1.83
32. Shanafelt, T. D., Dyrbye, L. N., Sinsky, C., Hasan, O., Satele, D., Sloan, J., & West, C. P. (2016, July). Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. In Mayo clinic proceedings (Vol. 91, No. 7, pp. 836-848). Elsevier. https://doi.org/10.1016/j.mayocp.2016.05.007
33. Sinsky, C. A., Willard-Grace, R., Schutzbank, A. M., Sinsky, T. A., Margolius, D., & Bodenheimer, T. (2014). In search of joy in practice. A report of 23 high-functioning primary care practices, 2013, 11.
34. Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., ... & Blike, G. (2016). Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Annals of internal medicine, 165(11), 753-760. https://doi.org/10.7326/M16-0961
35. Sudore, R. L., Schillinger, D., Katen, M. T., Shi, Y., Boscardin, W. J., Osua, S., & Barnes, D. E. (2018). Engaging diverse English-and Spanish-speaking older adults in advance care planning: the PREPARE randomized clinical trial. JAMA internal medicine, 178(12), 1616-1625. doi:10.1001/jamainternmed.2018.4657
36. Tai-Seale, M., Olson, C. W., Li, J., Chan, A. S., Morikawa, C., Durbin, M., ... & Luft, H. S. (2017). Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine. Health affairs, 36(4), 655-662. https://doi.org/10.1377/hlthaff.2016.0811
37. van den Berk‐Clark, C., Doucette, E., Rottnek, F., Manard, W., Prada, M. A., Hughes, R., ... & Schneider, F. D. (2018). Do patient‐centered medical homes improve health behaviors, outcomes, and experiences of low‐income patients? A systematic review and meta‐analysis. Health Services Research, 53(3), 1777-1798. https://doi.org/10.1111/1475-6773.12737
38. Weiner, S. J., Schwartz, A., Weaver, F., Goldberg, J., Yudkowsky, R., Sharma, G., ... & Abrams, R. I. (2010). Contextual errors and failures in individualizing patient care: a multicenter study. Annals of Internal Medicine, 153(2), 69-75. https://doi.org/10.7326/0003-4819-153-2-201007200-00002
39. White, A., & Danis, M. (2013). Enhancing patient-centered communication and collaboration by using the electronic health record in the examination room. Jama, 309(22), 2327-2328. doi:10.1001/jama.2013.6030
40. Willard-Grace, R., Hessler, D., Rogers, E., Dubé, K., Bodenheimer, T., & Grumbach, K. (2014). Team structure and culture are associated with lower burnout in primary care. The Journal of the American Board of Family Medicine, 27(2), 229-238. https://doi.org/10.3122/jabfm.2014.02.130215
41. Zhou, L., DeAlmeida, D., & Parmanto, B. (2019). Applying a user-centered approach to building a mobile personal health record app: development and usability study. JMIR mHealth and uHealth, 7(7), e13194. https://doi.org/10.2196/13194