Evidence map›Paper›PMID 28077235›Full record

ReviewLancet (London, England)2017

Drivers of poor medical care.

Vikas Saini, Sandra Garcia-Armesto, David Klemperer, Valerie Paris, Adam G Elshaug, Shannon Brownlee, John P A Ioannidis, Elliott S Fisher

Abstract readReview
PubMed Publisher
In one paragraph

Review in Lancet (London, England), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 103 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
103citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

103 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Pooled it
  4. Information provision for people with multiple sclerosis.The Cochrane database of systematic reviews · 2018
    Pooled it
  5. Pooled it
  6. Pooled it
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  8. Impact of Complex Quality-Interventions on Patient Outcome: A Systematic Overview of Systematic Reviews.Inquiry : a journal of medical care organization, provision and financing
    Pooled it
  9. Trial
  10. Global under- and overprescribing of drugs-a scoping review.Naunyn-Schmiedeberg's archives of pharmacology · 2026
    Review
  11. Article
  12. Article
  13. Underdiagnosis of Health: A Key Driver of Overdiagnosis of Disease.Journal of evaluation in clinical practice · 2026
    Article
  14. Article
  15. Review
  16. Article
  17. Review
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  19. Medication adherence, health outcomes, and perceived social performance in Black Americans receiving hemodialysis.Health psychology : official journal of the Division of Health Psychology, American Psychological Association · 2026
    Article
  20. Article

43 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Vikas SainiLown Institute, Brookline, MA, USA. Electronic address: vsaini@lowninstitute.org.
Sandra Garcia-ArmestoAragon Agency for Research and Development, Zaragoza, Spain; Aragon Health Sciences Institute, Aragon, Spain.
David KlempererOstbayerische Technische Hochschule Regensburg, Fakultät Angewandte Sozial-und Gesundheitswissenschaften, Regensburg, Germany.
Valerie ParisHealth Division, Organisation for Economic Co-operation and Development, Paris, France.
Adam G ElshaugLown Institute, Brookline, MA, USA; Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, University of Sydney, NSW, Australia.
Shannon BrownleeLown Institute, Brookline, MA, USA; Department of Health Policy, Havard T.H. Chan School of Public Health, Cambridge, MA, USA.
John P A IoannidisStanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford University, Stanford, CA, USA; Department of Statistics, Stanford University School of Humanities and Sciences and Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA.
Elliott S FisherThe Dartmouth Institute for Health Policy and Clinical Practice, Stanford University, Stanford, CA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The global ubiquity of overuse and underuse of health-care resources and the gravity of resulting harms necessitate an investigation of drivers to inform potential solutions. We describe the network of influences that contribute to poor care and suggest that it is driven by factors that fall into three domains: money and finance; knowledge, bias, and uncertainty; and power and human relationships. In each domain the drivers operate at the global, national, regional, and individual level, and are modulated by the specific contexts within which they act. We discuss in detail drivers of poor care in each domain.

Indexed as

Quality of Health CareAttitude of Health PersonnelDelivery of Health CareHealth BehaviorHealthcare FinancingHealth Knowledge, Attitudes, PracticeHumansModels, BiologicalPhysician-Patient Relations

Identifiers

PMID28077235

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.