Measures of diagnostic accuracy and timeliness

Donna Woods woods at NORTHWESTERN.EDU
Sun Jul 20 22:20:58 UTC 2014


Hi Cindy,
Here are a few thoughts:

One way may be to look at specific diagnoses. We have been working in a research frame on missing a stroke diagnosis by looking at ED admissions for things like dizziness and then looking for admissions for diagnosis of stroke in Abel's 8 hospital CAPRICORN database that includes NMH and 7 others. Misdiagnosed patients sometimes/ often go to other providers and facilities.

We could assess if this potentially could be applied to cancer diagnoses or MI diagnoses as well.

Sepsis misdiagnosis or delay in diagnosis within an institution could be another condition that could be assessed within an institution.

Returns to the ED with the same or worsening complaint could be a measure either within or across institutions. Using across institutional data would be stronger though.

I hope this is helpful.

Best,
Donna

Sent from my iPhone

On Jul 20, 2014, at 11:26 AM, "Barnard, Cindy" <CBarnard at NMH.ORG> wrote:

> Our Patient Family Advisory Council has asked that we develop or adopt some form of measurement of diagnostic accuracy and timeliness.  We have discussed with them the early stage of research and thinking on this topic, and they understand this, yet are urging focused action.
> 
> We have the obvious 'defect' measures - e.g. individual instances in which we identify an inaccurate or delayed diagnosis based on patient/clinician report or even autopsy, or rates of error or delay identified through systematic over-read of imaging, anatomic pathology, and other studies.
> 
> What we do not have is a systematic assessment of accurate and timely diagnosis in any population of patients.
> 
> What are measures in place in other organizations, and/or what measures should we be working to develop - balancing the undeniable importance of this topic with the impossibility of doing comprehensive routine medical record reviews - ?
> 
> Have you identified validated sampling approaches?  Trigger tools? EMR logic which would do initial case finding for subsequent record review?  Any actual metrics?
> 
> thanks
> Cindy Barnard
> 
> 
> 
> 
> 
> Cynthia Barnard
> Director, Quality Strategies
> 
> Northwestern Memorial Hospital
> 211 E Ontario #1550
> Chicago IL 60611
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> northwesternmedicine.org
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