Reducing Diagnostic Errors in Primary Care Pediatrics Toolkit

The Reducing Diagnostic Errors in Primary Care Pediatrics Toolkit aims to assist primary care practice teams with a systematic approach to reduce diagnostic errors among children in three important areas:

• Elevated blood pressure, which is misdiagnosed in 74 to 87 percent of children
• Adolescent depression, which affects nearly 10 percent of teenagers, and is misdiagnosed in almost 75 percent of adolescents
• Actionable pediatric diagnostic tests, which are potentially delayed up to 26 percent of the time.

This toolkit walks teams through the measurement, screening, recognition, diagnosis, follow-up, and reduction of diagnostic errors in these areas. It is based on clinical evidence, best practices, and a compilation of resources from the project, which involved over 100 primary care physicians and their care teams working across the United States to improve care for children.

By using this toolkit, primary care providers will be able to:

• Learn how to implement a systematic approach to providing safe and quality care to children
• Test strategies for improving care
• Access tools and best practices from national experts
• Reduce the likelihood of harm to children by identifying and decreasing diagnostic errors.

References

AHRQ Research Summit on Improving Diagnosis in Health Care, Rockville, Maryland, September 28, 2016.

Brady TM, Neu AM, Siberry G, Solomon B. Increased Provider Recognition of Elevated Blood Pressure in Children. American Society of Nephrology; 2012; San Diego, CA.

Ealovega MW, Tabaei BP, Brandle M, Burke R, Herman WH. Opportunistic screening for diabetes in routine clinical practice. Diabetes Care 2004;27:9-12.

Gandhi TK, Kachalia A, Thomas EJ, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Annals of Internal Medicine 2006;145:488-9.

Garrison CZ, Addy CL, Jackson KL, McKeown RE, Waller JL. Major depressive disorder and dysthymia in young adolescents. American Journal of Epidemiology 1992;135:792-802.

Glazebrook C, Hollis C, Heussler H, Goodman R, Coates L. Detecting emotional and behavioural problems in paediatric clinics. Child: Care, Health, and Development 2003;29:141-9.

Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA 2007;298:874-9.

Lewinsohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA. Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology 1993;102:133-44.

Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. Journal of the American Academy of Child and Adolescent Psychiatry 1996;35:865-77.

Singh H, Thomas EJ, Sittig DF, et al. Notification of abnormal lab test results in an electronic medical record: do any safety concerns remain? American Journal of Medicine 2010;123:238-44.

Whitaker A, Johnson J, Shaffer D, et al. Uncommon troubles in young people: prevalence estimates of selected psychiatric disorders in a nonreferred adolescent population. Archives of General Psychiatry 1990;47:487-96.