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Being forced to eliminate or introduce clinical services within any health care facility because of a budget cut can be extremely difficult and stressful. The appropriate decision-making steps need to be implemented to ensure success to the final outcome. This paper will discuss how one can use the Informed Decision Toolbox to effectively determine which clinical services can be introduced or eliminated in a county clinic with a budget cut of 15%. The best tool used for the decision as well as how the toolbox affects accountability and knowledge transfer will also be discussed. As a manager in a county clinic that provides health care to Medicaid patients, clinical services can become expensive for the facility. Within the clinic, numerous services are offered including: blood pressure screenings, blood sugar testing, pregnancy tests, flu/shingles/HPV vaccinations, yearly examinations for women, free antibiotics for patients, and affordable prescription drugs. Multiple services are offered at the clinic to alleviate the community traveling to different health care facilities for their health care needs. “It is believed that integration of care leads to greater public access, including more equitable access for people from different communities and socio-economic backgrounds, a more convenient and satisfying service, and better health overall” (Dudley & Garner, 2011, para. 2). It is difficult for one to eliminate any of these services because of the budget cut, so Rundall’s Informed Decision Toolbox came in to play to aid in finding the most logical answer. According to Rundall (2007), “The Informed Decision Toolbox (IDT) is an integrated set of tools that assists healthcare managers and policymakers in finding and assessing research evidence and in adapting and applying research evidence to important decisions in their organizations” (p.3). Rundall (2007) also

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