DX error by age groups

Donna Woods woods at NORTHWESTERN.EDU
Wed May 1 13:38:48 UTC 2013


Here is a link to a study we did looking at adverse events in pediatrics based on the CO and UT Medical Practice study data and compared children to non-elderly adults. The age group used is 0-20.99 compared with 21-65 years of age.

http://pediatrics.aappublications.org/content/115/1/155.long

The pediatric age group had significantly more diagnostic preventable adverse events than the non-elderly adults..
In all other types of events the likelihood is higher for adults.

I hope this is helpful.

Best,
Donna

Donna Woods, EdM, PhD
Research Associate Professor and
Co-Director, Graduate Programs in Healthcare Quality and Patient Safety and the
Northwestern Program for Quality and Safety Innovation
Centerfor Healthcare Studies,
Feinberg School of Medicine, Northwestern University
420 Superior Street, 10th Floor
Chicago, IL 60611
Phone:  847-571-2451
Email:  woods at northwestern.edu






From: Jason Maude [mailto:Jason.Maude at ISABELHEALTHCARE.COM]
Sent: Wednesday, May 01, 2013 5:16 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: DX error by age groups

Many thanks for these and other studies. As an observation , I think it would be very useful, where possible, in future studies to show not only the patients' mean age but also by group and I would suggest:  up to 16, 17-64 and over 65. In terms of thinking about solutions, I think it would be useful know whether there is a concentration of error in a particular type of patient which the mean doesn't really tell us.

Jason Maude
Founder and CEO Isabel Healthcare

From: <Thomas>, Eric <Eric.Thomas at uth.tmc.edu<mailto:Eric.Thomas at uth.tmc.edu>>
Date: Tuesday, 30 April 2013 19:52
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, JASON MAUDE <jason.maude at isabelhealthcare.com<mailto:jason.maude at isabelhealthcare.com>>
Subject: RE: DX error by age groups

Here are two studies that I have been involved in that partially answer your question.  For inpatients in the UT and CO Medical Practice Study there were not more diagnostic errors in the elderly (Table 3 in the second paper below), but in our recent study in the outpatient setting there were more (Table 1, first paper below).  I think that most clinicians would say they are more common in the elderly simply because their care is more complex.

Types and origins of diagnostic errors I primary care settings.  Singh H, Giardina TD, Meyer AN, Forjuoh SN, Reis MD, Thomas EJ.  JAMA Intern Med. 2013 Mar 25;173(6):418-25. PMID:23440149.

Thomas EJ, Brennan TA. Incidence and types of preventable adverse events in elderly patients: population based review of medical records.  BMJ. 2000 Mar 18;320(7237):741-4.
PMID:10720355

Eric

Eric J Thomas MD, MPH
Professor of Medicine
Associate Dean for Healthcare Quality
Director, UT Houston-Memorial Hermann Center for Healthcare Quality and Safety
The University of Texas Medical School at Houston
6410 Fannin UPB 1100.44
Houston, TX 77030
713-500-7958
www.utpatientsafety.org<http://www.utpatientsafety.org/>




From: Jason Maude [mailto:Jason.Maude at ISABELHEALTHCARE.COM]
Sent: Tuesday, April 30, 2013 10:11 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: DX error by age groups

I did mean by patient age but realise that by practitioner age is also an interesting question.


From: Bradford Winters <bwinters at JHMI.EDU<mailto:bwinters at JHMI.EDU>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Bradford Winters <bwinters at JHMI.EDU<mailto:bwinters at JHMI.EDU>>
Date: Tuesday, 30 April 2013 15:50
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: Re: DX error by age groups

Did you mean by patient age or practitioner age?

Bradford D. Winters, Ph.D., M.D.
________________________________
From: Geoff Norman [norman at MCMASTER.CA<mailto:norman at MCMASTER.CA>]
Sent: Tuesday, April 30, 2013 10:35 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: DX error by age groups
I have been tracking exactly this question for some time.. I have located probably 15 studies that address the question. First of all, it's easy to show a strong positive relationship with residency training, which is not the case if you look at measures like adherence to guidelines, ABIM performance etc. But beyond residency it's more tricky.I have not summarized the data quantitatively as yet, but I think the best guess is that there is a small negative relation between age and dx error, typically around -0.1.  And many outliers. In one study we did with elite internists, the best performer was 65, and the worst performer was 65.

But a tantalizing possibility is that it may follow the "10,000" hour curve and be curvilinear, peaking at around 45. There's just not enough data to find this.


Geoff

Geoff Norman
norman at mcmaster.ca<mailto:norman at mcmaster.ca>

MDCL 3519
McMaster University
1200 Main St. W.
Hamilton ON L8N3Z5, Canada

norman at mcmaster.ca<mailto:norman at mcmaster.ca>
(905) 525-9140, ext.22119





On 2013-04-30, at 5:46 AM, Jason Maude wrote:



Hi to the new group.

Does anybody know of any studies that show dx error by age group?

Many thanks


Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890
www.isabelhealthcare.com<http://www.isabelhealthcare.com/>

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