Impact of dx accuracy on antimicrobial therapy appropriateness

Bates, David Westfall,M.D. DBATES at PARTNERS.ORG
Sun Nov 10 15:28:31 UTC 2013


This is about average for how much difference CDS makes--is typically only 10-15% at margin for a bunch of domains (prevention, chronic disease management).  But across a population this is still a big win (on the one hand).  On the other, obvious opportunity to do a lot better--a big thing we need to learn about CDS is how to get more juice from it.  

David Bates

-----Original Message-----
From: Harold Lehmann [mailto:lehmann at JHMI.EDU] 
Sent: Saturday, November 09, 2013 10:29 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Impact of dx accuracy on antimicrobial therapy appropritateness

Thanks for pointing out this article.

I am struck that the CDSS increased the appropriateness rate only 11
percentage points (33%-->44%). I understand that this 11% represents a 33%
relative improvement, but I don't want to be biased by relative rates.

Is 11% big or small?

Shouldn't we demand an appropriateness rate of like 90%? What minimum
appropriateness rate would make us happy?

Harold

***************************************************************************
Harold P Lehmann, MD PhD
Professor and Interim Director
Division of Health Sciences Informatics
Johns Hopkins School of Medicine



On 11/8/13 11:53 AM, "Graber, Mark" <Mark.Graber at VA.GOV> wrote:

>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=2
>1102898943681
>
>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/>
>
>________________________________
>
>Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>
>To unsubscribe from IMPROVEDX: click the following link:
>http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A
>=1
>or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>Visit the searchable archives or adjust your subscription at:
>http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
>
>Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
>for Improving Diagnosis in Medicine
>
>To learn more about SIDM visit:
>http://www.improvediagnosis.org/
>
>To unsubscribe from the IMPROVEDX:
>mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>
>Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>
>For additional information and subscription commands, visit:
>http://www.lsoft.com/resources/faq.asp#4A
>
>http://LIST.IMPROVEDIAGNOSIS.ORG/ (with your password)
>
>Visit the searchable archives or adjust your subscription at:
>http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
>
>Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
>for Improving Diagnosis in Medicine
>
>To unsubscribe from the IMPROVEDX list, click the following link:<br>
><a 
>href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPRO
>VEDX&A=1" 
>target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SU
>BED1=IMPROVEDX&A=1</a>
></p>






Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>


The information in this e-mail is intended only for the person to whom it is
addressed. If you believe this e-mail was sent to you in error and the e-mail
contains patient information, please contact the Partners Compliance HelpLine at
http://www.partners.org/complianceline . If the e-mail was sent to you in error
but does not contain patient information, please contact the sender and properly
dispose of the e-mail.










More information about the Test mailing list