Diagnostic Errors – Extremely Important but How Can They be Measured?

Previous posts have emphasised the importance of diagnostic error.[1] [2] Prescient perhaps, since the influential Institute of Medicine has published a report into diagnostic error in association with the National Academies of Sciences, Engineering, and Medicine.[3] Subsequently, McGlynn et al. highlight the importance of measurement of diagnostic errors.[4] There is no single, encompassing method of measurement, while the three most propitious methods (autopsy reports, malpractice cases, and record review) all have strengths and weaknesses. One of the particular issues with record review, not brought out, is that one of the most promising interventions that could tackle the issue, computerised decision support, is likely to also affect the accuracy of the measurement of diagnostic errors. So we are left with a big problem that is hard to quantify in a way that is unbiased with respect to the most promising remedy. Either we have to measure IT based interventions using simulations (arguably not generalizable to real practice), or changes in rates among post-mortems or malpractice claims (arguably insensitive). There is yet another idea – to design computer support systems so that the doctor must give his provisional diagnosis before the decision support is activated, and then see how often the clinician alters behaviours in a way that can be traced back to any additional diagnosis suggested by the computer?

— Richard Lilford, CLAHRC WM Director

Reference:

  1. Lilford RJ. Bad Apples vs. Bad Systems. NIHR CLAHRC West Midlands News Blog. 20 February 2015.
  2. Lilford RJ. Bring Back the Ward Round. NIHR CLAHRC West Midlands News Blog. 20 March 2015.
  3. Balogh EP, Miller BT, Ball JR (eds.). Improving Diagnosis in Health Care. National Academies of Sciences, Engineering, and Medicine. 2015.
  4. McGlynn EA, McDonald KM, Cassel CK. Measurement Is Essential for Improving Diagnosis and Reducing Diagnostic Error. JAMA. 2015; 314(23): 2501-2.
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