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In its landmark report, Crossing the Quality Chasm, the Institute of Medicine set out six aims for high-quality medical care: that care should be effective, efficient, equitable, safe, timely, and patient-centered. A significant part of the quality of medical care is determined by the large and small decisions that doctors and patients make every day about seeking care, having tests, starting treatments, and stopping treatments. It is important to know to what extent decisions contribute to or detract from quality of care. To a great extent, the quality of a decision depends on the decision situation, on the perspective of the person who is judging the quality, and on what is being judged (e.g., whether it is the decision or the decision maker that is ...

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