EHRs Used to Identify Wrong Diagnosis, How Care Could Be Improved

Electronic Newsletter, Issue 381

AHRQ's Electronic Newsletter summarizes Agency research and programmatic activities.

May 30, 2013

AHRQ Stats

More than $138 billion was spent on health services for women ages 18 to 39 in 2009. Pregnancy and normal childbirth, mental disorders, asthma and chronic obstructive pulmonary disease, and bronchitis and upper respiratory infections accounted for one-third ($47 billion) of the spending. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #403, Health Care Expenditures for the Most Commonly Treated Conditions of Women Ages 18 to 39, 2009).

Today's Headlines

  1. EHRs Used to Identify Wrong Diagnosis, How Care Could Be Improved.
  2. AHRQ Tools Can Help Health Care Providers Follow Asthma Guidelines.
  3. Decision Support Systems for HPV Vaccine Featured in Two AHRQ Studies.
  4. AHRQ's Health Care Innovations Exchange Focuses on Improving Care for Frontier Populations.
  5. AHRQ Review Finds SmartPill Equally Effective at Detecting Gastroparesis and Constipation.
  6. Get the Basics on Preventing Adverse Events after Hospital Discharge from AHRQ's PSNet.
  7. AHRQ in the professional literature.

1. EHRs Used to Identify Wrong Diagnosis, How Care Could Be Improved

Most cases of wrong diagnosis (diagnostic errors) occur with common ailments and are related to process breakdowns that happen during visits with health care providers, according to a study supported by AHRQ. Researchers used electronic health records to identify cases of diagnostic error in primary care settings. Some of the most commonly missed conditions were pneumonia, heart failure, kidney failure, or new cancers. Failures in taking patient histories, physical examination and follow-up testing were the most common contributors to wrong diagnosis, which can put patients at risk for moderate to severe harm. Better methods are needed to help clinicians gather and synthesize information, especially for illnesses that have similar symptoms, the study concludes. "Types and Origins of Diagnostic Errors in Primary Care Settings" appeared online March 25 in JAMA Internal Medicine. Select to access the abstract on PubMed®.

2. AHRQ Tools Can Help Health Care Providers Follow Asthma Guidelines

Decision support tools, feedback and audit, and clinical pharmacy support may improve the adherence to asthma guidelines among health care providers, according to a new research review from AHRQ. Further research should evaluate other types of health care provider-targeted interventions, with a focus on standardized measures of outcomes such as missed school days or work days, more rigorous study designs, and additional cost measures. These findings and others can be found in the research review, Interventions to Modify Health Care Provider Adherence to Asthma Guidelines.

3. Decision Support Systems for HPV Vaccine Featured in Two AHRQ Studies

Providing families and clinicians with information to support decisions about starting and completing the human papillomavirus (HPV) vaccine series increases appropriate use of the vaccine, an AHRQ-funded study shows. The HPV vaccine is effective in preventing some types of cervical cancer and requires a total of three shots given over 6 months. The study evaluated the impact of family education and electronic alerts for clinicians on vaccination rates. Electronic alerts for clinicians were most likely to impact delivery of the first shot, while education and reminders for families were associated with the second and third vaccine shots. "The Implementation and Acceptability of an HPV Vaccination Decision Support System Directed at Both Clinicians and Families" appeared in the 2012 AMIA Annual Symposium Proceedings. Select to access the abstract on PubMed®. An additional AHRQ-funded study on HPV support systems, "Effectiveness of Decision Support for Families, Clinicians, or Both on HPV Vaccine Receipt," appeared in the May issue of Pediatrics. Select to access that abstract on PubMed®.

4. AHRQ's Health Care Innovations Exchange Focuses on Improving Care for Frontier Populations

The latest issue of AHRQ's Health Care Innovations Exchange features three programs that used innovative approaches to overcome barriers to health care access in frontier settings. One of the featured profiles, Improving Care for Frontier Populations, describes a program that combines a change in reimbursement policy with additional Federal funding to allow five primary care clinics in Alaska and Washington to stay open around the clock. This enables them to care for patients who cannot be transported to the nearest hospital or who need a period of monitoring and observation before returning home. Through two Federal demonstration projects, five clinics under the Frontier Extended Stay Clinic program received additional reimbursement to cover stays of up to 48 hours, along with funds to cover the costs of facility and staff upgrades. The policy changes have significantly reduced medical evacuations, saving nearly $14 million; improved quality of care; and generated high levels of satisfaction among community members served by the clinics. Select to access more innovation profiles and tools related to rural health care and to telemedicine on the Innovations Exchange Web site, which contains more than 775 searchable innovations and 1,525 Quality Tools.

5. AHRQ Review Finds SmartPill Equally Effective at Detecting Gastroparesis and Constipation

The SmartPill wireless motility capsule (WMC) has similar accuracy to current testing methods for detecting gastroparesis (delayed gastric emptying) or slow-transit constipation, finds a new review from AHRQ's Effective Health Care Program. WMC is a small device that, when swallowed, can detect specific transit times in the stomach, small bowel, and colon. This device is a portable, one-time use, ingestible capsule that records and transmits data to a receiver as it travels through the gut. WMC could improve how clinicians test for these conditions because the capsule does not involve any radioactive material or x-ray exposure and can record information about pressure, transit, and location simultaneously. More research is needed to evaluate how the capsule should be used in combination with or instead of other testing modalities. These findings can be found in the full research review, Wireless Motility Capsule Versus Other Diagnostic Technologies for Evaluating Gastroparesis and Constipation: A Comparative Effectiveness Review.

6. Get the Basics on Preventing Adverse Events after Hospital Discharge from AHRQ's PSNet

Adverse drug events are the most frequent complication that patients experience after they are discharged from the hospital, according to a patient safety primer available on AHRQ's Patient Safety Network (PSNet). The primer provides background and relevant, research-based information to help hospital staff reduce the incidence of adverse events that cause readmissions. It suggests that hospital staff follow a systematic approach, including implementing an effective medication reconciliation program; communicating information about the patient's medication changes, pending tests, and follow-up needs with outpatient physicians; and educating patients and families about their diagnosis and follow-up needs. Select to access the full patient safety primer, titled Adverse Events after Hospital Discharge.

7. AHRQ in the Professional Literature

Paul Olson TJ, Brasel KJ, Redmann AJ, Alexander GC, et al. Surgeon-reported conflict with intensivists about postoperative goals of care. JAMA Surg 2013 Jan; 148(1):29-35. Select to access the abstract on PubMed®.

Lyell DJ, Chambers AS, Steidtmann D, et al. Antenatal identification of major depressive disorder: a cohort study. Am J Obstet Gynecol 2012 Dec; 207(6):506.e1-506.e6. Select to access the abstract on PubMed®.

Curtis JR, van der Helm-van Mil AH, Knevel R, et al. Validation of a novel multibiomarker test to assess rheumatoid arthritis disease activity. Arthritis Care Res 2012 Dec; 64 (12):1794-1803. Select to access the abstract on PubMed®.

Hughes CG, Patel MB, Pandharipande PP. Pathophysiology of acute brain dysfunction: what's the cause of all this confusion? Curr Opin Crit Care 2012 Oct; 18(5):518-26. Select to access the abstract on PubMed®.

Fehr JJ, Honkanen A, Murray DJ. Simulation in pediatric anesthesiology. Pediatr Anesth 2012 Oct; 22(10):988-94. Select to access the abstract on PubMed®.

Moran J, Scanlon D. Slow progress on meeting hospital safety standards: learning from the Leapfrog Group's efforts. Health Aff 2013 Jan; 32(1):27-35. Select to access the abstract on PubMed®.

Kim DJ, Westfall AO, Chamot E, Willig AL, Mugavero MJ, Ritchie C, Burkholder GA, et al. Multimorbidity patterns in HIV-infected patients: the role of obesity in chronic disease clustering. J Acquir Immune Defic Syndr 2012 Dec 15; 61(5):600-5. Select to access the abstract on PubMed®.

Hillegass WB, Patel MR, Klein LW, et al. Long-term outcomes of older diabetic patients after percutaneous coronary stenting in the United States: a report from the National Cardiovascular Data Registry, 2004 to 2008. J Am Coll Cardiol 2012 Dec 4; 60(22):2280-9. Select to access the abstracton PubMed®.

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Current as of May 2013
Internet Citation: EHRs Used to Identify Wrong Diagnosis, How Care Could Be Improved: Electronic Newsletter, Issue 381. May 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/381.html