Table 2 Representative Quotes of Internal Factors

 Severity of concern/health

“I first prioritize what the veteran’s goal of the visit is, but I also look at what would be most threatening, in terms of their long-term health. If the issue at that time is that the COPD or asthma is uncontrolled, and they’re wheezing and short of breath, I’d be more likely to address that.” (P00)

 Response to observable data

“You prioritize with your vitals – if […] his blood pressure is extremely high, got to really address that; if his sugars are really extremely high. I actually usually do address both of those.” (P13)

 Decisions are unique

“For some people their struggle is […] clinical. For other people their struggling is social. For other people it’s economic. For other people it’s mental health.” (P17)

 Physicians have a style or preferred approach

“Part of my job is to be the coach and encourager and know that this is a lifelong process. You’ve got to make small changes that are permanent, but you can’t try and make everything change all at once.” (P11)

 Documentation is bidirectional with care decisions

“If you have time to prep, that’s always a good thing, because you can either go over the home monitoring stuff or like I said, go back to your previous notes: 'OK, I know I needed to ask about this, because I made a note about it in my last note.'” (P06)

 Stability or status-quo

“I ask him: ‘Are you status-quo today or is there something different going on?’ And then I look to these others [to] make sure that’s stable.” (P21)

 Patient goals, acute needs take priority

“Whatever the patient feels to be the absolute necessary to address, but there are times we start examining them and other things take over because they absolutely need to be addressed. Then anything else like chronic disease that needs to be addressed.” (P01)