Impact of dx accuracy on antimicrobial therapy appropritateness

Graber, Mark Mark.Graber at VA.GOV
Fri Nov 8 16:53:12 UTC 2013


Most physicians still look at me with disbelief when I talk about a diagnostic error rate of 10-15%, so the figures in this paper (55%) are really quite amazing.  The method they used to determine a diagnostic error isn't exactly clear from reading the paper, but its from a good group and this seemed to reflect the retrospective opinion from two ID physicians.

If we ever start using better tests to differentiate viral from bacterial upper respiratory track infections, I'm guessing the error rates in this setting would be similarly high.

Jason said it well - quality care begins with the right diagnosis.

________________________________
From: Jason Maude <Jason.Maude at ISABELHEALTHCARE.COM>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Jason Maude <Jason.Maude at ISABELHEALTHCARE.COM>
Date: Fri, 8 Nov 2013 10:58:41 -0500
To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] Impact of dx accuracy on antimicrobial therapy appropritateness

This is a fascinating study which adds a whole new dimension to the issue of improving diagnostic accuracy. It shows how important diagnostic accuracy is to appropriate antimicrobial (AM) therapy.

http://www.jstor.org/discover/10.1086/670627?uid=3738032&uid=2&uid=4&sid=21102898943681

Key facts that jumped out were that:

 1.  Initial provider diagnosis was considered correct in only 55% of cases
 2.  When the initial diagnosis was correct the AM therapy was considered appropriate in 62% of cases. When the initial diagnosis was incorrect, uncertain, or a sign or symptom then the AM was only appropriate in 11% of cases. This completely blows away the idea that often it doesn't matter if the diagnosis is not made or correct as the treatment would be the same anyway.
 3.  Overall across the 500 cases, the diagnosis was not correct in 163 (33%) of cases and in only 13 of those cases was the AM therapy appropriate.
 4.  The authors stated that "the study confirmed the tremendous impact of diagnostic accuracy on AM appropriateness"

This study set out to look at whether AM appropriateness improved when CDSS was used but on the assumption that the initial diagnosis was correct. What they found instead was that dx accuracy had much more impact on AM appropriateness rather than the use of therapy CDSS.

This study helps show the tremendous impact diagnostic accuracy has on not just AM therapy but on so many crucial aspects of healthcare. It shows the complete futility of trying to improve healthcare without improving diagnosis, the first and most important decision made about the patient.

Regards
Jason

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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