Laying the Groundwork to Improve Diagnosis in Health Care

"The Agency’s continued support helped to sustain an annual conference series dedicated to promoting change to improve diagnosis and eliminate harm in partnership with patients, their families, the health care community, and every interested stakeholder."

Mark L. Graber, M.D., Professor Emeritus of Medicine at Stony Brook University, New York, and a senior fellow at RTI International, is one of the country’s leading authorities in the field of patient safety. Dr. Graber has pioneered efforts to focus on diagnostic safety, including founding and leading the Society to Improve Diagnosis in Medicine and the journal Diagnosis.

Following the release of the Institute of Medicine’s landmark 1999 report, To Err is Human: Building a Safer Health System, much of the focus was on health care system issues that led to errors. The report, which contained very few specifics on diagnostic errors, led Dr. Graber and his colleagues to posit that safe and effective care presumes that the patient receives the correct diagnosis.

In 2008, Dr. Graber received AHRQ grant funding to establish the "Diagnostic Error in Medicine" conference, which helped to pave a path for a new scientific discipline. Additional AHRQ funding in subsequent years helped to establish this conference as a recognized forum where researchers and clinicians focus on issues at the intersection of diagnostic reasoning and medical error. "AHRQ’s initial financial support came at a critical period in the formation of the conference," said Dr. Graber.  "The Agency’s continued support helped to sustain an annual conference series dedicated to promoting change to improve diagnosis and eliminate harm in partnership with patients, their families, the health care community, and every interested stakeholder," he added.

As the nation’s patient safety agency, AHRQ is now leading federal efforts to improve diagnostic safety. As part of this effort, AHRQ worked with experts like Dr. Graber and his colleagues to host the "Improving Diagnosis in Health Care" research summit in September 2016. The summit built on findings from "Improving Diagnosis in Health Care" (PDF, 424 KB), a 2015 National Academy of Medicine report that analyzed the state of diagnosis in health care. (Dr. Graber served on the committee responsible for developing the report.) As the report makes clear, despite the best efforts of clinicians, diagnostic errors persist throughout all settings of care. The report concluded that most people will experience at least one diagnostic error in their lifetime.

Dr. Graber has also helped lay the groundwork to raise the profile of patient safety in general. In 2002, he co-founded Patient Safety Awareness Week, an internationally recognized health observance that has helped to keep a spotlight on patient safety. Dr. Graber is also a recipient of the John M. Eisenberg Patient Safety and Quality Awards for achievement in advancing patient safety and health care quality. The patient safety awards program honors the late John M. Eisenberg, M.D., a former director of AHRQ.

Principal Investigator: Mark L. Graber, M.D., Senior Fellow
Institution: RTI International
Grantee Since:  2008
Type of Grant:  Conference grant

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