Fwd: 'Contextual Errors' Costly, but Not Being Measured

Koppel, Ross J rkoppel at SAS.UPENN.EDU
Thu May 12 01:06:36 UTC 2016


This is a very important and very powerful insight.  Thank you...and I hope more continue to work on this insight.  It speaks to issues of usability, visual presentation of data, design of the EHR, interactions with patients and caregivers....and so much more.


Again, Bravo.


Ross


Ross Koppel, PhD, FACMI

UNIVERSITY OF PENNSYLVANIA

Sociology Dept;  LDI Senior Fellow, Wharton; &

Affil Fac. Sch. of Medicine.

Chair, AMIA Clinical Information Systems Working Group.

Ph: 215 576 8221; Cell 215 518 0134



________________________________
From: Shojania, Dr. Kaveh <Kaveh.Shojania at SUNNYBROOK.CA>
Sent: Wednesday, May 11, 2016 3:35 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Fwd: 'Contextual Errors' Costly, but Not Being Measured


That group does indeed do good work.



FYi, they published a follow up paper (from the Annals one) with us at BMJ  Qual Saf this year. Providers contextualise care more often when they discover patient context by asking: meta-analysis of three primary data sets



http://qualitysafety.bmj.com/content/25/3/159.full?sid=68c4af69-6aac-4baa-89e0-7d327eb1cbad



Analyzing 3 different data sets (one being the one from the Annals paper the Medscape article mentions), they showed that docs acted on social context issues (eg, food insecurity or job loss) when coming up with a care plan arm more often if the docs had inquired about possible problems as opposed to the patient spontaneously bringing it up.



When we were reviewing the paper and sending minor revisions requests to the authors, I mentioned that the result reminded me a little of a paper from the medical decision making lit in which Don Redelemeier and colleagues showed that clinicians assign more weight to information that they have to work to obtain – e.g, in forming a diff diagnosis. [Redelmeier DA, Shafir E, Aujla PS. The beguiling pursuit of more information. Med Decis Making 2001;21:376–81. ]



It was a minor point and I didn’t tell the authors they had to reference it, but the first author apparently knew of the paper already and happily added to the discussion.

The Redelmeier study is more an example of a cog bias of the type people like to think about in the context of Dx errors. The problem about not paying as much attention to important assertions by patients that are made spontaneously instead of in reply to questions obviously adds other regrettable elements ;)



-kgs



Kaveh G. Shojania, MD

Professor and Vice Chair, Quality & Innovation

Department of Medicine, University of Toronto

Director, Centre for Quality Improvement and Patient Safety (C-QuIPS)

http://www.cquips.ca/



Editor-in-Chief,

BMJ Quality & Safety



Sunnybrook Health Sciences Centre

Room H468, 2075 Bayview Avenue

Toronto, Ontario M4N 3M5

Phone: 416-480-6100 x 89608

Fax: 416-480-6777

Email kaveh.shojania at sunnybrook.ca<mailto:kaveh.shojania at utoronto.ca>



From: David L Meyers [mailto:dm0015 at COMCAST.NET]
Sent: Wednesday, May 11, 2016 2:10 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] Fwd: 'Contextual Errors' Costly, but Not Being Measured



A link to an interesting news story on Medscape, reporting on material presented at a recent ACP conference.



http://www.medscape.com/viewarticle/863033?src=rss



David

David L Meyers, MD FACEP

Listserv Moderator/Board member

Society to Improve Diagnosis in Medicine

Save the Date: Diagnostic Error in Medicine, November 6-8, 2016, Los Angeles, CA
Save the Date: DEM-Europe, June30-July 1, 2016, Rotterdam, The Netherlands











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