[EXTERNAL] [IMPROVEDX] quick ?

Alan Morris Alan.Morris at IMAIL.ORG
Wed Apr 23 19:35:06 UTC 2014


I think Ross Koppel has it right.  Since we do not know the
decision-making process used by the clinicians, we cannot know how well
they performed.  The reported figures are likely largely underestimated,
in my view.
Have  a nice day.

Alan H. Morris, M.D.



On 4/23/14, 12:32 PM, "Ross Koppel" <rkoppel at SAS.UPENN.EDU> wrote:

>First, I want to second Mark's comment.  It very much depends on the
>methodology used.  Hardeep's methodology (as all methods) is limited to
>the parameters he used (charts, return visits, etc).  While fine
>research (he's one of my heroes), it cannot be representative of the
>larger error rate, which would have to reflect the conditions that were
>unknown and did not appear in charts or in subsequent revisits or
>re-admits. I don't know what that ratio is, but it's non-trivial.  Very
>non-trivial.  Then, of course, as has been argued here, there's the
>definition of Dx error.  If it's delayed to the point that something
>could have been done but was not, that's different than if it took a few
>years but made no difference.
>
>Ross
>
>Ross Koppel, Ph.D. FACMI
>Sociology Dept and Sch. of Medicine
>Senior Fellow, LDI, Wharton
>University of Pennsylvania, Phila, PA 19104-6299
>215 576 8221 C: 215 518 0134
>
>On 4/23/2014 1:32 PM, Graber, Mark wrote:
>> Stephen,
>>
>> We (I) believe the risk of diagnostic error in general medical settings
>>in the US is in the range of 10 - 15%  (Graber.  The Incidence of
>>Diagnostic Error in Medicine;  BMJ Qual Saf 2013;22:ii21-ii27.
>>doi:10.1136/bmjqs-2012-001615).  That's all errors, most of which
>>(thankfully) are inconsequential or caught.  The risk of harm is clearly
>>much less and its hard to put a number on that.
>>
>> The news stories centered on Hardeep's recent article  ( The frequency
>>of diagnostic errors in outpatient care: estimations from three large
>>observational studies
>> involving US adult populations.  Singh H, et al. BMJ Qual Saf
>>2014;0:1-5. doi:10.1136/bmjqs-2013-002627) where they identified a risk
>>of approximately 5% from chart reviews in primary care clinics.  That
>>number is in the 10-15% ballpark, given that the approach would have
>>missed errors that weren't obvious from the medical record, and errors
>>for which the consequences played out elsewhere, and other methodologic
>>issues.
>>
>> All of these numbers are based on research approaches.  So far, there
>>aren't any healthcare organizations I know of that are measuring error
>>rates in real time, and the challenges of actually doing this are
>>substantial.  We have little data on the error rate for surgical
>>patients, or patients seen in the ER.  There is a great need for
>>research on this question, and for finding reliable and reproducible
>>ways to find and count these errors going forward.  You can't improve
>>what you can't measure.
>>
>> Mark
>>
>> Mark L Graber, MD FACP
>> Senior Fellow, RTI International
>> Professor Emeritus, SUNY Stony Brook School of Medicine
>> Founder and President, Society to Improve Diagnosis in Medicine
>> Phone:   919 990-8497
>>
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