DX measures

Thomas Westover twest54973 at YAHOO.COM
Thu Dec 6 19:18:23 UTC 2018


Agree 100% mark

The metric we put forth should NOT primarily be about the evolution of the ICD10 dx from clinic to admission to discharge and back to clinic

It’s partly a self fulfilling prophecy ... Because the “easy simple ” cases (those that classic ax aka concordant with the usual illness script) are dxed early  while the “complex atypical” cases (those that are discordant with the usual illness script ) are dxed late 

An “observed to expected” ratio is not  useful in my mind 

The ideal metric will measure the clinical reasoning process itself as it is occurring (ideally without the clinicians even realizing that they are being surveilled)

The questions on the clinical reasoning toolkit would be a good start in my opinion 

Tom

Thomas Westover MD


Sent from my iPhone

> On Dec 6, 2018, at 11:29 AM, Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG> wrote:
> 
> Jason – thanks for continuing to press us all to develop practical measures we could all support that would lead to improved diagnosis. 
>  
> I do agree that concordance between an admission and discharge diagnosis might be one measure of the adequacy of the diagnostic process in the ambulatory setting.  But at the end of the day, I’d argue that ‘getting it right’ is likely more important than getting it right in the clinic alone.
>  
> The agreement between admission and discharge diagnosis is fairly easy to measure and study, but this parameter is complicated !  First, in many hospitals the discharge diagnoses are assigned by coders whose primary goal seems to be centered on optimizing billing, not to capture diagnostic accuracy.  Second, and I may be old-fashioned here, but in my humble opinion there is no better time or place to make a diagnosis or to revise an initial impression.  It is so much easier to concentrate on a patient’s problems, consider and complete diagnostic evaluations, and get opinions from others during an inpatient stay compared to stretching these out over time and space in the ambulatory setting.  In this framework, any difference between the admitting and the discharge diagnosis is likely to be to the patient’s advantage and a good thing.  The disagreement noted in this study is almost certainly multifactorial, but if I had to guess, this data may be saying something positive about the diagnostic process in showing that the recorded diagnosis did in fact evolve during the admission.
>  
>     Mark
>  
> Mark L Graber, MD FACP
> Chief Medical Officer; Founder and President Emeritus, SIDM
> Professor Emeritus, Stony Brook University, NY
>  
>  
> From: Jason Maude <jason.maude at ISABELHEALTHCARE.COM>
> Reply-To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Jason Maude <jason.maude at ISABELHEALTHCARE.COM>
> Date: Thursday, December 6, 2018 at 9:41 AM
> To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: [IMPROVEDX] DX measures
>  
> This is a very interesting study (freely available) looking at the degree of match between the admission diagnosis and what the authors call the exit diagnosis.
>  
> “Our results show that only the 21.67% of cases are identified correctly on admission….”
>  
> Could this be used as a measure for diagnosis quality in hospitals? I am sure there will be concerns about the admitting diagnosis and clinicians being rushed to put something down without enough time but the ratio between the 2 diagnoses for an institution as a whole should be a useful indicator as would the trend over time. If the measure drove institutions to focus of getting the admitting diagnosis more accurate then that would be good.
>  
> This should also be practical to produce as would not involve the clinicians in any additional work.
>  
> In an earlier discussion, I asked if there were any measures that were practical, where there were no concerns and that we could all support but got replies. I really feel that if we are to get diagnosis the respect it deserves from hospitals and health systems then we need a measure. We have all been talking about this for a long time, but I do not sense we are any further forward!
>  
> Regards
>  
> Jason Maude
> Founder and CEO Isabel Healthcare
> Tel: +44 1428 644886
> Tel: +1 703 879 1890
> www.isabelhealthcare.com
>  
>  
> 
> 
> 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:David Meyers, Board Member, Society for Improving Diagnosis in Medicine
> 
> To learn more about SIDM visit:
> http://www.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:David Meyers, Board Member, Society for Improving Diagnosis in Medicine
> 
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


HTML Version:
URL: <../attachments/20181206/7f32cae2/attachment.html>


More information about the Test mailing list