To understand the incidence and nature of diagnostic errors in healthcare, providers must refer to a number of data sources and research methods.
The committee that authored the Institute of Medicine's recent "Improving Diagnosis in Health Care" report highlighted eight data sources and research methods providers can use to better understand the incidence and likelihood of diagnostic errors, summarized below.
1. Autopsies. Postmortem examinations offer a very strong method for identifying diagnostic errors because of the extensiveness of the examination that is possible. The authoring committee suggests increasing the number of such exams to develop better estimates of diagnostic error incidence.
2. Medical records. Developing a standard method of documenting errors that could be applied to a random sample of patient records would enhance opportunities to learn about both the incidence and the likelihood of patients experiencing a diagnostic error.
3. Malpractice claims. For malpractice claims to be more useful for estimating the incidence of diagnostic errors, more research needs to be dedicated to evaluating the probability that a claim will be filed if an error has occurred and the likelihood that a filed claim will be settled.
4. Health insurance claims. Claims databases maintained by CMS and by commercial insurers allow researchers to measure certain types of diagnostic errors, identify their downstream clinical consequences and costs and understand the factors associated with diagnostic errors on a system, healthcare professional and patient level.
5. Diagnostic testing. Diagnostic tests have made substantial contributions to the study of diagnostics but to better understand the potential of this data source, the authoring committee suggests developing new methods for identifying the diagnoses for which such testing is necessary, as well as mechanisms to evaluate the appropriateness of test ordering.
6. Medical imaging. Medical imaging plays a crucial role in many diagnoses, and mistakes made in the use and interpretation of these images can lead to diagnostic errors. By identifying cases in which medical imaging results were central to making the diagnosis, researchers can determine the likelihood of errors, the nature of those errors and the circumstances under which errors occur.
7. Clinician surveys. To make national estimates of the incidence of diagnostic errors more accurate, clinician survey sampling frames should be more clearly defined and questions about the nature and circumstances surrounding an error should be more detailed.
8. Patient surveys. Patients are uniquely positioned to offer information on the front end of the diagnostic process and on how physicians explain errors to patients. Information on both of these steps is critical to improving the diagnostic process and estimating error incidence.
To read the full report, click here.
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