how to teach about cognitive bias

Shanu Gupta shanuguptamd at GMAIL.COM
Thu Jan 24 18:29:30 UTC 2019


Check out MedEdPortal
<https://www.mededportal.com/search/?q=Cognitive%20Errors> - there are
several interesting workshops that you might find useful.

On Thu, Jan 24, 2019 at 1:18 PM Anderson, Timothy M. CMOVAMC <
000000177ee7f24e-dmarc-request at list.improvediagnosis.org> wrote:

> Has anyone found a short (hour) presentation on cognitive bias to teach
> resident physicians?
>
>
>
> *From:* Michael H. Kanter [mailto:Michael.H.Kanter at KP.ORG]
> *Sent:* Wednesday, January 23, 2019 10:40 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [EXTERNAL] Re: [IMPROVEDX] how to teach about cognitive bias
>
>
>
> Do you have a link or excerpt for the NASA decision making process?
>
>
>
> *From:* Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG>
> *Sent:* Wednesday, January 23, 2019 2:45 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] how to teach about cognitive bias
>
>
>
> *Caution: *This email came from outside Kaiser Permanente. Do not open
> attachments or click on links if you do not recognize the sender.
> ------------------------------
>
> Probably no one (maybe the CIA?) has thought more about the cognitive bias
> problem than NASA.  Cognitive errors were at the root of both the
> Challenger and Columbia disasters, for instance. There was also a
> fascinating case study of an incident aboard the International Space
> Station that was really just a (near fatal) diagnostic error, like the ones
> we see:  Astronaut Luca Parmitano experience water accumulating in his
> helmet during an extra-vehicular activity that was attributed to his
> inadvertently squeezing the ‘drink bag’ on the front of his space suit; no
> harm done.  The next week during another EVA, water again began filling up
> his helmet, this time to the point that he was near asphyxiation before he
> could return to the interior of the station. The real problem was not the
> drink bag at all, as initially diagnosed, but a faulty water-recirculation
> unit in the suit.
>
>
>
> NASA has devoted *considerable* attention to the decision-making process
> that they employ as an organization, and they rely very extensively on
> normative decision-making whenever possible. But they also recognize
> “System 1” will come into play in daily activities.  Astronaut training
> therefore includes modules on decision-making that explore the dual-process
> model.  In their Space Flight Resource Manual, decision-making heavily
> emphasizes the use of group involvement (Crew Resource Management), but
> also provides advice for the individual, which they term the STAR model.
> (See Below).  Looks pretty similar to our advice in medicine to avoid
> System 1 errors:  Stop and Think !    NASA also provides to their astronaut
> trainees very extensive training opportunities (many under adverse
> conditions) that include decision-making as part of the activity.
>
>
>
> A few years ago, SIDM received a very small grant from NASA to review
> their decision-making process and make recommendations.  The report is
> buried somewhere on their website, but I’d be happy to provide excerpts to
> anyone interested.
>
>
>
>      Mark
>
>
>
> Mark L Graber MD FACP
>
> Chief Medical Officer; Founder and President Emeritus, SIDM
>
> Professor Emeritus, Stony Brook University, NY
>
>
>
> *From: *Sherrill Franklin <sfranklin131 at GMAIL.COM>
> *Reply-To: *Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>,
> Sherrill Franklin <sfranklin131 at GMAIL.COM>
> *Date: *Wednesday, January 23, 2019 at 7:53 AM
> *To: *Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> *Subject: *Re: [IMPROVEDX] how to teach about cognitive bias
>
>
>
> Rob,
>
>
>
> I’m not sure if the aviation industry as a whole recommends cognitive bias
> training for the medical profession, but “Sully Sullenberger” of
> landing-on-the Hudson-fame is an advocate for patient safety in this
> article in Stanford Medicine
> <https://urldefense.proofpoint.com/v2/url?u=https-3A__med.stanford.edu_news_all-2Dnews_one-2Dto-2Done_2012_sully-2Dsullenberger-2Dtakes-2Don-2Dpatient-2Dsafety.html&d=DwMGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=FQ38r4X63Qr6FgohAP9o9c87WsuxhjHYMO1xW11Nzog&m=Wye7SP86cs_pZvJ3hhJY1g_mIiI-oeA0WtyZVgsx9hk&s=prWG1DUvGK3s8US3GrviPrxnzHymrl_oPVAbNkGC--s&e=>
> .
>
>
>
> Also--
>
>
>
> I found this cognitive training report for pilots. Perhaps training
> materials could be adapted for physicians and other health care providers.
> Full PDF is attached at the end.
>
> *1.1 **Key **Findings *
>
> * Aeronautical *Decision Making (ADM) can be **taught both **in a
> classroom **and **a **simulator environment*. The principles and concepts
> of ADM have been accepted and used by a wide variety of civil and
> military aircraft users performing a multitude of missions.
>
> * *All **formalized **ADM **training **seems **to improve safety* through significant
> reductions in Human Performance Error accident rates.
>
> * These widespread successes have generated a need for second generation ADM
> training materials for use in recurrency training and to more adequately address
> the cognitive processing needs of experienced pilots.
>
> *t *The NTSB has recommended that the FAA pursue the implementation of
> ADM more vigorously following a fatal accident between an airplane and a helicopter
> in April 1991.
>
> ** Expert cognitive performance is characterized by **rapid **access **to
> **a **well organized **body **of conceptual **and procedural **knowledge*.
> This is a modifiable information structure based upon knowledge that is
> experienced. This experience allows the perception of large meaningful patterns
> in familiar and new situations which help the expert match goals to task demands.
> This means they can respond creatively or with opportunistic solutions based
> upon a global perception of the meaningful relationships in a situation.
>
> * Experienced **pilots have exhibited expert cognitive performance
> through keen, quick, confident decisions and almost **a **direct
> perception of the proper course of action. These decisions occur so rapidly
> it appears to be **a **cognitive process and **behavioral resultant **based
> upon insight or intuition. This intuitive performance **is **based upon: **experience
> (cognitive and sensory, internal and external); the cues and context of **the
> **situation; **and, the expert's ability to identify causal relationships
> in a situation.*
>
> * *The development **of these expert pilot cognitive processes can be
> correlated with the growth in other aviator skills which result from
> training and experience.* The ability to develop a second generation of
> ADM mateinals to teach or train these skills will require a more thorough
> understanding of how experts use past experience to assess new
> situations, make decisions and define goals.
>
> ** The expert pilot **is **adaptive. **He/she can perceive the necessity
> to alter (or not **to **alter) ingrained **conceptual and procedural
> knowledge based upon the parameters and dynamics (cues and context) of the
> problem or situation encountered. *
>
> * *Experiencing **situations repeatedly throughout an aviation career
> enhances a pilot's cognitive processing* by providing reinforcement of knowledge
> to apply to similar new situations, by providing more associative paths
> to speed-up recall of knowledge and by providing elaborations on previous situations
> which can be used for both recall and inference.
>
> * *Experience **can also interfere with the perception of **a **situation
> and provide negative reinforcement for later use in bad decision making.* Job
> or personal stress, anxiety, fixation, emotional blocking, etc. will
> affect the stored knowledge negatively and it will not be usable in new
> situations.
>
> * Experience or training that is intended to be used for the development
> of expert pilot cognitive processing development must insure the
> perception of the essential psycho physiological elements of the problem.
> The appropriateness experience will be critical to the subjective
> associations and stored knowledge patterns that will be used in new
> situations.
>
>
> ------------------------------
>
>
>
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>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=DwQGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=FQ38r4X63Qr6FgohAP9o9c87WsuxhjHYMO1xW11Nzog&m=Wye7SP86cs_pZvJ3hhJY1g_mIiI-oeA0WtyZVgsx9hk&s=yHebpDhf3wTYQmpvQQNnrF_hi7gxPwZEhfM5ObOGjI0&e=>
>
>
>
>
>
> Sherrill Franklin
>
> 129 E. Harmony Road
>
> West Grove, PA 19390
>
>
>
> EMAIL: sfranklin131 at gmail.com <sfranklin131 at gmail.com>
>
> PHONE:  (610) 869-4234
>
>
>
> On Jan 23, 2019, at 12:01 AM, Robert Bell <
> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> wrote:
>
>
>
> Very interesting discussion.
>
>
>
> Is bias considered in air pilot simulation training? How do they include
> that?
>
>
>
> Does the airline industry believe that simulation training would be useful
> in medicine?
>
>
>
> Rob Bell
>
>
>
> On Tuesday, January 22, 2019, 9:43:18 PM MST, Nelson Toussaint <
> ntoussaint at TAMARAC.COM> wrote:
>
>
>
>
>
>
>
>
>
> October 5, 2015
>
> 9:30 PM
>
>
>
> Last summer, I had an opportunity to tour the Hartford HealthCare CESI Lab
> where there is a lot of Simulation in action.  They also have an operator
> that can interject scenario issues to provide unexpected patient responses
> to clinicians during the activity to help them deal with abnormal
> conditions.  I believe this is mainly teaching surgery functions at this
> time.
>
>
>
>    Nelson Toussaint
>
>
>
> TAMARAC LLC
>
> 860-844-0199
>
> ntoussaint at tamarac.com
>
>
>
>
>
> *From:* Sherrill Franklin [mailto:sfranklin131 at GMAIL.COM
> <sfranklin131 at GMAIL.COM>]
> *Sent:* Sunday, January 20, 2019 5:48 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] how to teach about cognitive bias
>
>
>
> Dear Dr. Bell,
>
>
>
> Yes~ Simulators could provide great training for every conceivable medical
> situation—from helping practitioners with cognitive bias, to identifying
> invisible, but debilitating autoimmune diseases to burn care.  Here are
> some uses (below) of simulators already “in the works.” One is a
> collaboration with Harvard/MIT, another is in use for plastic surgeons,
> another for brain surgery. Some of these articles are a bit old, so, as you
> mentioned, maybe there were obstacles that prevented further development.
> Or perhaps, these capable people just need a bit more running room to work
> out the kinks...
>
>
>
> https://harvardmedsim.org/training/simulation-instructor-training/
> <https://urldefense.proofpoint.com/v2/url?u=https-3A__harvardmedsim.org_training_simulation-2Dinstructor-2Dtraining_&d=DwMGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=FQ38r4X63Qr6FgohAP9o9c87WsuxhjHYMO1xW11Nzog&m=Wye7SP86cs_pZvJ3hhJY1g_mIiI-oeA0WtyZVgsx9hk&s=oaY-I6Rf9PnmeAIv4Nl9_dnEI5TywMeKyhwvw0Aj_Mg&e=>
>
>
>
>
> https://news.wisc.edu/flight-simulator-for-surgeons-project-joins-computer-science-with-medicine
> <https://urldefense.proofpoint.com/v2/url?u=https-3A__news.wisc.edu_flight-2Dsimulator-2Dfor-2Dsurgeons-2Dproject-2Djoins-2Dcomputer-2Dscience-2Dwith-2Dmedicine&d=DwMGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=FQ38r4X63Qr6FgohAP9o9c87WsuxhjHYMO1xW11Nzog&m=Wye7SP86cs_pZvJ3hhJY1g_mIiI-oeA0WtyZVgsx9hk&s=UCg_ibowEV9yogm5laa0MijqFenO5Rk1jXepbQnbS7c&e=>
>
>
>
> https://www.technologyreview.com/s/415104/a-simulator-for-brain-surgeons/
> <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.technologyreview.com_s_415104_a-2Dsimulator-2Dfor-2Dbrain-2Dsurgeons_&d=DwMGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=FQ38r4X63Qr6FgohAP9o9c87WsuxhjHYMO1xW11Nzog&m=Wye7SP86cs_pZvJ3hhJY1g_mIiI-oeA0WtyZVgsx9hk&s=_cHGy7Xdnsdyolcbu4bts1PrVLOidoWmrFYkCFcaaoE&e=>
>
>
>
>
>
> My best,
>
>
>
> Sherrill Franklin
>
> 129 E. Harmony Road
>
> West Grove, PA 19390
>
>
>
> EMAIL: sfranklin131 at gmail.com <sfranklin131 at gmail.com>
>
> PHONE:  (610) 869-4234
>
>
>
> On Jan 20, 2019, at 4:15 PM, Robert Bell <
> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> wrote:
>
>
>
> Dear Pat Kroskerry,
>
>
>
> Sounds promising,
>
>
>
> I have always felt that medical training would be enhanced using airline
> flight simulator-like approaches.
>
>
>
> Have these been introduced to medicine yet, and are they effective?
>
>
>
> Not having heard a lot about such training either here or elsewhere I am
> presuming that there are intrinsic problems as it pertains to medicine?
>
>
>
> If so it would be sad when one considers the tremendous improvement in
> Safety by the global airline industry over the last 50 years or so.
>
>
>
> Is it true that there ARE significant problems?
>
>
>
> Rob Bell, M.D.
>
>
>
> On Sunday, January 20, 2019, 10:55:58 AM MST, Pat Croskerry <
> croskerry at EASTLINK.CA> wrote:
>
>
>
>
>
> Tom: apologies for the delay in responding. I believe this approach has
> significant potential for teaching about diagnostic failure.
>
> Jonathan Howard has just published a case-based guide to critical thinking
> in medicine: Cognitive errors and diagnostic mistakes (Springer) – a great
> resource.
>
> We have been using a similar approach here at Dalhousie for a number of
> years. Our teaching manual which documents in detail about 40 cases of
> cognitive error in diagnosis will be published by OUP this year.
>
> Another useful exercise is to take the cases published by Charles Pilcher
> (Medical Malpractice Insights (MMI): Learning from Lawsuits) and work out
> the cognitive biases likely involved.
> https://madmimi.com/p/fa0e2d?fe=1&pact=76716-148560539-8457174274-2b6f035f60fb4d603a886574b0a5af25e2c8ab1d
> <https://urldefense.proofpoint.com/v2/url?u=https-3A__madmimi.com_p_fa0e2d-3Ffe-3D1-26pact-3D76716-2D148560539-2D8457174274-2D2b6f035f60fb4d603a886574b0a5af25e2c8ab1d&d=DwMGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=FQ38r4X63Qr6FgohAP9o9c87WsuxhjHYMO1xW11Nzog&m=Wye7SP86cs_pZvJ3hhJY1g_mIiI-oeA0WtyZVgsx9hk&s=kgato_qEUA8JTWMCagGW_rKN-yAFqFvZoGV1PUsMx8k&e=>
>
>
>
>
> Pat Croskerry MD, PhD, FRCP(Edin)
>
> Professor, Department of Emergency Medicine,
>
> Director, Critical Thinking Program,
>
> Dalhousie University Medical School,
>
> Halifax, Nova Scotia
>
> CANADA
>
>
>
>
>
>
>
>
>
> *From:* Thomas Westover <
> 000000040134e744-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
> *Sent:* December 7, 2018 2:03 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] how to teach about cognitive bias
>
>
>
> Thanks for that tip Lorie
>
>
>
> I spent a little time today glancing thru the tool kits; It seems that
> they are more academic overviews than specific examples
>
>
>
> would it be worthwhile for the SIDM community to "crowd source" and have
> interested SIDM members submit short (1-2 paragraph) case
> descriptions/illness scripts that illustrate specific cognitive biases
> (anchoring premature closure etc etc)
>
>
>
> these could be reviewed by an ad hoc expert group of senior SIDM leaders
> for vetting and then posted on the SIDM website for dissemination to
> residency program directors, medical school faculty members etc
>
>
>
> I would certainly be interested in such a teaching tool
>
>
>
> Thanks
>
> Tom
>
>
>
>
>
> Thomas Westover MD
>
> Cooper Medical School
>
> NJ
>
>
>
>
>
>
>
>
>
> On Thursday, December 6, 2018, 2:32:44 PM EST, Lorie Slass <
> Lorie.Slass at IMPROVEDIAGNOSIS.ORG> wrote:
>
>
>
>
>
> There is info on the SIDM site that may be helpful –
>
>
>
>    1. Assessment of Reasoning Tool
>    <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.improvediagnosis.org_art_&d=DwMGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=FQ38r4X63Qr6FgohAP9o9c87WsuxhjHYMO1xW11Nzog&m=Wye7SP86cs_pZvJ3hhJY1g_mIiI-oeA0WtyZVgsx9hk&s=DrcyyXnBZNtdU9MMcFRCLQ9AtAS-mymG9fRKzQXCyfE&e=>
>    – this was developed as a tool to support educators in assessing a
>    learner’s clinical reasoning skills during patient presentations. On the
>    page there are a number of videos that look at elements of clinical
>    reasoning.
>    2. The Clinical Reasoning Toolkit
>    <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.improvediagnosis.org_clinicalreasoning_&d=DwMGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=FQ38r4X63Qr6FgohAP9o9c87WsuxhjHYMO1xW11Nzog&m=Wye7SP86cs_pZvJ3hhJY1g_mIiI-oeA0WtyZVgsx9hk&s=PiQQFNbYTknOJR9MmxTHUNidN6BTKDDvCNLql4FdaWU&e=>
>    includes great resources.  Resources in the ‘how we make decisions’ section
>    includes many that focus on cognitive bias -
>    https://www.improvediagnosis.org/clinical-reasoning-toolkit-how-we-make-decisions/
>    <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.improvediagnosis.org_clinical-2Dreasoning-2Dtoolkit-2Dhow-2Dwe-2Dmake-2Ddecisions_&d=DwMGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=FQ38r4X63Qr6FgohAP9o9c87WsuxhjHYMO1xW11Nzog&m=Wye7SP86cs_pZvJ3hhJY1g_mIiI-oeA0WtyZVgsx9hk&s=sfIWGb7x142ZjCisktA1DkQV2wrFEFj-OPtP0ktvj1w&e=>
>    3. We maintain a ‘foundational reading’ section
>    <https://urldefense.proofpoint.com/v2/url?u=https-3A__www.improvediagnosis.org_foundational-2Dreadings_&d=DwMGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=FQ38r4X63Qr6FgohAP9o9c87WsuxhjHYMO1xW11Nzog&m=Wye7SP86cs_pZvJ3hhJY1g_mIiI-oeA0WtyZVgsx9hk&s=D6PP6hl_M5artci2HPxRBSfosEUuHB6RGC_TIBp1GwA&e=>
>    that includes readings/studies related to cognitive reasoning.
>
>
>
> Hope these are helpful.
>
>
>
>
>
> _________________________________________
>
> Lorie Slass
> Vice President of Communications and Marketing
> Society to Improve Diagnosis in Medicine (SIDM)
> *Lorie.Slass at ImproveDiagnosis.org <Lorie.Slass at ImproveDiagnosis.org>*
> Phone: 215.801.4057
> www.improvediagnosis.org
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.improvediagnosis.org_&d=DwMGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=FQ38r4X63Qr6FgohAP9o9c87WsuxhjHYMO1xW11Nzog&m=Wye7SP86cs_pZvJ3hhJY1g_mIiI-oeA0WtyZVgsx9hk&s=yHebpDhf3wTYQmpvQQNnrF_hi7gxPwZEhfM5ObOGjI0&e=>
> <image001.jpg>
>
>
>
> *From:* Thomas Westover <
> 000000040134e744-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
> *Sent:* Thursday, December 6, 2018 2:05 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] how to teach about cognitive bias
>
>
>
> Does the sidm website have a list of short case presentations that are
> good examples of the various cognitive biases that have been reviewed in
> the literature ?
>
>
>
> I would like to do a short cognitive bias review session at the beginning
> of our weekly M&M rounds
>
>
>
> To teach students and residents about what these constructs are and how
> they are relevant in decision making
>
>
>
> And to teach them that understanding clinical reasoning is just as
> important as obtaining the correct dx
>
>
>
> Thanks
>
>
>
> Tom
>
>
>
> Thomas Westover MD
>
> Sent from my iPhone
>
>
> On Dec 6, 2018, at 1:04 PM, Jarrett, Mark P <MJarrett at NORTHWELL.EDU>
> wrote:
>
> Mark
>
>
>
> I agree – but we often see anchoring based on the initial diagnosis that
> leads to less than ideal outcomes. The key to me is both a good
> differential (don’t always have to be right out of the gate) and purposeful
> reflection and re-evaluation.
>
>
>
> Mark
>
>
>
>
>
> Mark Jarrett, MD, MBA, MS
>
> SVP & Chief Quality Officer
>
> Associate Chief Medical Officer
>
> Northwell Health
>
> Professor of Medicine
>
> Zucker School of Medicine at Hofstra/Northwell
>
> (O): 516-321-6044
>
> (C): 917-796-3935
>
> mjarrett at northwell.edu
>
>
>
>
>
>
>
> *From: *Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG>
> *Reply-To: *Society to Improve Diagnosis in Medicine <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Mark Graber <
> Mark.Graber at IMPROVEDIAGNOSIS.ORG>
> *Date: *Thursday, December 6, 2018 at 11:31 AM
> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> *Subject: *[EXTERNAL] Re: [IMPROVEDX] DX measures
>
>
>
> *External Email. Use Caution.*
>
> 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
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>
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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