How to Improve Diagnosis? Measure It, Say JAMA Authors

The September report from the Institute of Medicine highlighted how common and costly diagnostic errors can be. It defined such an error as failing to establish an accurate and timely explanation of a patient’s health problem or failing to communicate that explanation to the patient.

Taking on this problem, according to 3 authors writing in JAMA, requires measuring the scope of diagnostic errors, because reducing them starts with figuring out how back the problem is. The authors are no strangers to measurement: Elizabeth A. McGlynn, PhD, Kaiser Permanente Center for Effectiveness and Safety Research and the Center for Primary Care and Outcomes Research; Kathryn M. McDonald, MM, of the Center for Health Policy, Stanford University; and Christine K. Cassel, MD, president and CEO, the National Quality Forum.

The authors outline 5 purposes for measuring diagnostic errors: to establish the magnitude of the problem, to determine the causes and risks of diagnostic error, to evaluate the effectiveness of interventions, to assess skills in education and training, and to establish accountability in diagnostic performance. Assuming that the current steps toward promoting value-based care, such as pay-for-performance incentives, would be naïve. Training must emphasize clinical reasoning skills as well as the appropriate use of tests and technology.

Just as the current healthcare reform efforts are demanding more patient engagement, so, too, much other stakeholders be engaged in the movement for better diagnostic processes. Feedback is critical, and so is research. The federal government must take a lead role—and it must be the mission of an agency, as at the moment is it not. This will not be acceptable, the authors suggest, because of “the demand for public reporting of performance measures and increasing use of value-based purchasing in both the public and private sectors.”

The report on diagnostic errors found that despite overall efforts to improve healthcare quality, the essential step in the chain—assessing and diagnosing what is wrong with the patient—has received less than adequate attention. The 21-member Committee on Diagnostic Error in Health Care examined the diagnostic process in light of the following:

• At least 5% of US adults experience diagnostic error each year in outpatient settings, and most adults will experience at least 1 diagnostic error in their lifetime.
• The report found that a lack of data makes it hard to determine the full scope of errors (thus the need for measurement).
• Postmortem exams show diagnostic errors contribute to roughly 10% of patient deaths.
• Diagnostic errors are responsible for 6% to 7% of hospital adverse events.
• By far, diagnostic errors account for the largest number of paid medical malpractice claims; errors are twice as likely to result in deaths compared with other claims.

Reference

McGlynn EA, McDonald KM, Cassel CK. Measurement is essential for improving diagnosis and reducing diagnostic error. JAMA. 2015;314(23):2501-2502.