AHRQ Grants for Diagnostic Error

Phillip Benton pgbentonmd at AOL.COM
Mon Apr 13 21:22:55 UTC 2015


Rob & Mark,


Yes, theoretically the insurance carrier should be the primary filter, but most of the reviewer's who pre-certify (approve/turn down) surgery requested have little or no formal medical education, and operate strictly from a computer screen that lists what they will or will not approve for a certain diagnosis. Whether it is unnecessary or excessive at that point in time (with so little symptomatic disease, confirmed by appropriate studies) is outside their discretion.


'Second Opinion' also falls short of controlling inappropriate or unnecessary surgery (see L. Leape, attached). In small communities, friends may approve each other's cases without the insurors' knowledge. Some specialty societies, such as North American Spine Society, are working actively to establish 'surgical appropriateness criteria' to help apply the clinical practice guidelines its' dedicated guideline committees have worked so hard to formulate.


Many have written about this (Leape, Epstein, others) but no one yet has tried to take real action. Deyo & Mirza in 2010 described a 15-fold increase in complex surgery for spinal stenosis (as occured in my Power Point example) between 2002 and 2007. 


The JC's Mission Statement extols 'Quality Care and Patient Safety' in hospitals it accredits, but it has not yet acknowledged or confronted the problem of  unnecessary or excessive surgery. When asked JC says they depend upon the hospitals QA committees to control this -- but there are no guidelines, no monitoring and no sanctions for cases such as that described in my Spinal Stenosis PowerPoint. I am preparing a presentation to The Joint Commission on this point and I may ask SIDM to weigh in. 

Phil Benton
Atlanta, GA




-----Original Message-----
From: robert bell <rmsbell at ESEDONA.NET>
To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Sent: Mon, Apr 13, 2015 2:32 pm
Subject: Re: [IMPROVEDX] AHRQ Grants for Diagnostic Error


Excellent point. 
  
 
 
Where are the loyalties of the Joint Commission - are the mainly patient or hospital?  Who pays the JCs fees? I ask this as there seem to be 100s many areas where the JC could help reduce errors to a far greater extent. Accurate data collection could be a start.  
  
   
  
  
Insurance carriers often are asking for approval for expensive procedures, operations, or drugs. Do they ever challenge a surgeons decision to perform an operation?  Are second opinions ever sought in those situations?  Could the Insurance Carriers be the filter that you ask for?  
  
   
  
  
But let’s not forget ambulatory care diagnostic errors, which must be massive, when so many do not have the training to diagnose many of the conditions.  
  
   
  
  
Rob Bell  
 
 
  
 
 
  
   
On Apr 13, 2015, at 10:32 AM,     pgbentonmd at aol.com wrote:   
   
   
          
      Rob, Mark and SIDM,     
      
      
      
      
      I would like to add another very important area in which "diagnostic" errors may cause massive and irreparable patient harm. I'm talking about not an error of diagnosis, but about the misapplication of surgical treatment indications for some diagnoses.. Currently there are no barriers to posting surgery that is inappropriate (viz unnecessary or excessive) for the underlying diagnosis.     
      
      
      
      
       Patients usually have given their "informed" consent to the procedure because they trusted their physician. Most physicians are trustworthy, but some surgeons looking to enhance the surgical fee treat surgically all pathology seen on the diagnostic imaging, or do the surgery prematurely. Attached, anonymized, is one example.     
      
      
      
      
      What we really need is a diagnosis related "appropriateness criteria" screening system at the surgery scheduling desk that the OR nurses can understand and apply, that can trigger review of questionable case postings by senior surgeons with departmental administrative responsibility for quality of care. The Department Chair will also need timely backup consultation available from specialty society Practice Guidelines Committees when needed.     
      
      
      
      
      Hopefully Joint Commission will face the problem and       join this effort to ensure patient safety and quality care in America's accredited hospitals.     
      
      
      
      
      Phillip G. Benton, MD, JD     
      
      Atlanta, Georgia     
 
 
      
-----Original Message-----      
 From: robert bell <      rmsbell at ESEDONA.NET>      
 To: IMPROVEDX <      IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>      
 Sent: Mon, Apr 13, 2015 11:33 am      
 Subject: Re: [IMPROVEDX] AHRQ Grants for Diagnostic Error      
       
       
        
 That was the point I was trying to make previously, and asking where most diagnostic errors are to be found.  In hospitals or in private specialty practice and primary care practice?         
          
         
         
 If it is thought that most diagnostic errors come from the latter, then funding should be be available there.          
          
           
          
          
 Rob Bell           
           
            
             
 On Apr 12, 2015, at 4:24 PM, Julianne Nemes Walsh <              nemeswalsh at GMAIL.COM> wrote:             
             
             
              
 After reviewing the grant criteria, primary care practice groups that are not attached to a higher ed institution are not eligible.   Would love to see grant opportunities available to smaller settings to stimulate more diversified opportunities for all levels of providers interested in diagnostic error.                
              
               
               
 On Thu, Apr 9, 2015 at 9:52 PM,                <graber.mark at gmail.com> wrote:                
                
                 
                  This is a big day for our diagnostic safety community:  AHRQ has just issued the first-ever grant announcement that specifically targets “ Diagnostic Safety in Ambulatory Care”.  Both R01 (large grants) and R18 (small grants) will be funded under this initiative, which will be open annually until 2018.  With so many proposed, but untested interventions that have been raised, there’s many opportunities.  Go get ‘em !                  
                   
                  
                  
                   Mark                  
                  
                   
                  
                  
                   Mark L Graber MD FACP                  
                  
                   President, SIDM                    
                  
                   
                    
                     
                      
                     
                     
                      Title:     Understanding and Improving Diagnostic Safety in Ambulatory Care: Strategies and Interventions   

Deadline Date:  Standard due dates apply: January 25, May 25, and September 25.

For details, click on the link below:
http://www.egrants.net/Public/index.cfm?ID=17660&UserID=graber%2Emark%40gmail%2Ecom
                     
                    
                    
                    
                     
                      or copy the above link into your web browser and hit the enter key.                      
                      
                      
                     
                    
                   
                   
                  
                 
                 
                 
                 
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                     Robert M. Bell, M.D., Ph.C.                    
                    
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     <Spinal_Stenosis.ppt_BASIC +.pptx>   
  
 
 
 
   
   
    
           
                 
           Robert M. Bell, M.D., Ph.C.          
          
           P.O. Box 3668          
          
           West Sedona, AZ  86340-3668          
          
           USA          
          
           Tel: Fax: 928 203-4517          
          
           
          
I am changing my e-mail address to        rmsbell200 at yahoo.com               
      
       
      
      
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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