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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 486 Research Studies DisplayedHickey EJ, Feinberg E, Kuhn J
Family impact during the time between autism screening and definitive diagnosis.
The purpose of this study was to explore parental perceptions of the impact their child’s behavior had on their family between the time risk of Autism Spectrum Disorder (ASD) was identified and before formal medical diagnosis, and then compare family impact among those whose child met diagnostic criteria for ASD and those who did not. The study found that the parents of children who received a non-ASD diagnosis reported a higher baseline level of family impact. Perception of difficult child behavior was a stronger predictor of family impact than later diagnostic group, and child functioning did not predict family impact. The researchers concluded that in this specific population, perceived difficult child behavior is a stronger predictor of family impact than later diagnostic category.
AHRQ-funded; HS022242.
Citation: Hickey EJ, Feinberg E, Kuhn J .
Family impact during the time between autism screening and definitive diagnosis.
J Autism Dev Disord 2022 Nov;52(11):4908-20. doi: 10.1007/s10803-021-05354-5..
Keywords: Autism, Screening, Diagnostic Safety and Quality
Umeukeje EM, Koonce TY, Kusnoor SV
Systematic review of international studies evaluating MDRD and CKD-EPI estimated glomerular filtration rate (eGFR) equations in Black adults.
The authors conducted a systematic review to assess how well estimating glomerular filtration rate (eGFR), with and without race adjustment, estimates measured GFR (mGFR) in Black adults globally. They identified 12 studies which included patients with and without kidney disease from Africa, the United States, Europe, and Brazil. They found that the majority of these studies determined that removal of race adjustment improved bias, accuracy, and precision of eGFR equations for Black adults. They concluded that their systematic review supports the need for future studies to be conducted in diverse populations to assess the possibility of alternative approaches for estimating GFR.
AHRQ-funded; HS026122.
Citation: Umeukeje EM, Koonce TY, Kusnoor SV .
Systematic review of international studies evaluating MDRD and CKD-EPI estimated glomerular filtration rate (eGFR) equations in Black adults.
PLoS One 2022 Oct 18;17(10):e0276252. doi: 10.1371/journal.pone.0276252..
Keywords: Kidney Disease and Health, Chronic Conditions, Racial / Ethnic Minorities, Diagnostic Safety and Quality
Severance TS, Njuguna F, Olbara G
An evaluation of the disparities affecting the underdiagnosis of pediatric cancer in Western Kenya.
This study described the international collaboration to investigate disparities affecting the underdiagnosis of pediatric cancer in Western Kenya. Estimates of cancer incidence in similar populations around the world would indicate approximately 1500 patients should be diagnosed each year. However, internal review at a large tertiary hospital noted 200-250 patients were diagnosed annually, suggesting the remaining 75-80% of patients go undiagnosed and do not receive treatment. The authors reviewed 41 malaria slides at a local referring hospital that demonstrated both morphologic and genetic evidence of leukemia. This disparity suggested a lack of education and training that were the lead factors contributing to lower rates of diagnosis.
AHRQ-funded; HS026390.
Citation: Severance TS, Njuguna F, Olbara G .
An evaluation of the disparities affecting the underdiagnosis of pediatric cancer in Western Kenya.
Pediatr Blood Cancer 2022 Oct;69(10):e29768. doi: 10.1002/pbc.29768..
Keywords: Children/Adolescents, Cancer, Disparities, Diagnostic Safety and Quality
Luximon DC, Ritter T, Fields E
Development and interinstitutional validation of an automatic vertebral-body misalignment error detector for cone-beam CT-guided radiotherapy.
The purpose of this study was to develop an automatic error detection algorithm that uses a three-branch convolutional neural network error detection model (EDM) to detect off-by-one vertebral-body misalignments using planning computed tomography (CT) images and setup CBCT images. The researchers collected algorithm training and test data from 480 patients undergoing radiotherapy treatment at two radiotherapy clinics. One model (EDM(1) ) was trained solely on data from institution 1. EDM(1) was further trained on a dataset from institution 2 to produce a fine-tuned model, EDM(2) . Another model, EDM(3), was trained using a training dataset composed of data from both institutions. The study found that when applied to the combined test set, EDM(1) , EDM(2) , and EDM(3) resulted in an area under curve of 99.5%, 99.4%, and 99.5%, respectively. EDM(1) achieved a sensitivity of 96% and 88% on Institution 1 and Institution 2 test set, respectively. EDM(2) obtained a sensitivity of 95% on each institution's test set. EDM(3) achieved a sensitivity of 95% and 88% on Institution 1 and Institution 2 test set, respectively. The researchers concluded that in CBCT-guided radiotherapy, the proposed algorithm demonstrated accuracy in identifying off-by-one vertebral-body misalignments that was sufficiently high enough to justify implementation in practice.
AHRQ-funded; HS026486.
Citation: Luximon DC, Ritter T, Fields E .
Development and interinstitutional validation of an automatic vertebral-body misalignment error detector for cone-beam CT-guided radiotherapy.
Med Phys 2022 Oct;49(10):6410-23. doi: 10.1002/mp.15927..
Keywords: Imaging, Diagnostic Safety and Quality, Medical Errors, Patient Safety
Shafer GJ, Singh H, Thomas EJ
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
The objective of this study was to determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. The "Safer Dx NICU Instrument" was used to review electronic health records. The reviewers discovered that the frequency of diagnostic error in inborn NICU patients during the first 7 days of admission was 6.2%.
AHRQ-funded; HS027363.
Citation: Shafer GJ, Singh H, Thomas EJ .
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
J Perinatol 2022 Oct;42(10):1312-18. doi: 10.1038/s41372-022-01359-9..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Bradford A, Shofer M, Singh H
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
This paper discusses Measure Dx, a new AHRQ resource that translates knowledge from diagnostic measurement research into actionable recommendations. This resource guides healthcare organizations to detect, analyze, and learn from diagnostic safety events as part of a continuous learning and feedback cycle. The goal of Measure Dx is to advance new frontiers in reducing preventable diagnostic harm to patients.
AHRQ-authored; AHRQ-funded; 233201500022I; HS027363.
Citation: Bradford A, Shofer M, Singh H .
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
Int J Qual Health Care 2022 Sep 10;34(3). doi: 10.1093/intqhc/mzac068..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality Improvement, Quality of Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Systems, Learning Health Systems
Odeh Couvertier V, Patterson Patterson, Zayas-Cabán G
Association between advanced image ordered in the emergency department on subsequent imaging for abdominal pain patients.
The purpose of this retrospective, observational study was to evaluate abdominal pain patients discharged from the ED to determine the association between advanced emergency department (ED) imaging on subsequent outpatient imaging and on revisits. The researchers utilized the electronic health records of Medicare patients who presented with a complaint of abdominal pain at a United States academic emergency department. The study found that participants who were not imaged at the ED had significantly higher adjusted odds of being imaged outside of the ED within 7, 14, and 28 days of being discharged, and had a significantly higher adjusted odds of returning to the study ED and visiting any ED within 30 days of being discharged. The study concluded that receiving abdominal imaging services in the ED was related with significantly lower imaging use after discharge.
AHRQ-funded; HS024558.
Citation: Odeh Couvertier V, Patterson Patterson, Zayas-Cabán G .
Association between advanced image ordered in the emergency department on subsequent imaging for abdominal pain patients.
Acad Emerg Med 2022 Sep;29(9):1078-83. doi: 10.1111/acem.14541..
Keywords: Imaging, Emergency Department, Diagnostic Safety and Quality, Hospital Readmissions
Bradford A, Shahid U, Schiff GD
Development and usability testing of the Agency for Healthcare Research and Quality common formats to capture diagnostic safety events.
The purpose of this study was to conduct a usability assessment of the Agency for Healthcare Research and Quality (AHRQ) Common Formats for Event Reporting for Diagnostic Safety Events (CFER-DS) to assist in informing future revisions and implementation. The researchers recruited quality and safety personnel from 8 U.S. healthcare organizations and invited them to use the CFER-DS to simulate reporting and then provide written and verbal qualitative feedback. The study found that feedback about item clarity and content coverage was generally positive, but that reporter burden was a potential concern. Participants also identified opportunities to improve the CFER-DS, including clarifying several conceptual definitions, improving applicability across different care settings, and creating guidance to operationalize use of the tool.
AHRQ-authored; AHRQ-funded; HS027363, 233201500022I.
Citation: Bradford A, Shahid U, Schiff GD .
Development and usability testing of the Agency for Healthcare Research and Quality common formats to capture diagnostic safety events.
J Patient Saf 2022 Sep 1;18(6):521-25. doi: 10.1097/pts.0000000000001006..
Keywords: Diagnostic Safety and Quality, Patient Safety, Health Information Technology (HIT), Adverse Events
Williams JP, Nathanson R, LoPresti CM
Current use, training, and barriers in point-of-care ultrasound in hospital medicine: a national survey of VA hospitals.
This study aimed to characterize current point-of-care ultrasound (POCUS) use, training needs, and barriers to use among hospital medicine groups (HMGs). This prospective observation study looked at all Veterans Affairs (VA) medical centers from August 2019 to March 2020 using a web-based survey sent to all chiefs of HMGs. There was a 90% response rate from 117 HMGs. Procedural POCUS use decreased by 19% from 2015 to 2020 but increased for diagnostic use for cardiac (8%), pulmonary (7%), and abdominal (8%) applications. The most common barrier to POCUS use was lack of training (89%), with only 34% of HMGs having access to POCUS training. Access to ultrasound equipment was the least common barrier at 57%, however with the proportion of HMGs with ≥1 ultrasound machine increasing from 29% to 71% from 2015 to 2020. In 2020 an average of 3.6 ultrasound devices per HMG was available, and 45% were handheld devices.
AHRQ-funded; HS025979.
Citation: Williams JP, Nathanson R, LoPresti CM .
Current use, training, and barriers in point-of-care ultrasound in hospital medicine: a national survey of VA hospitals.
J Hosp Med 2022 Aug;17(8):601-08. doi: 10.1002/jhm.12911..
Keywords: Imaging, Training, Hospitals, Diagnostic Safety and Quality, Provider: Clinician
Ramesh S, Ayres B, Eyck PT
Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit.
This retrospective study used chart reviews of critically ill children in the pediatric intensive care unit (PICU) to determine the impact of subspecialty consultations on diagnosis. The majority of patients (87 of 101) were provided subspecialty consultations at the request of the PICU clinician. The consultations were equally for diagnosis (65%) and treatment (66%). There was a change in diagnosis for 21% of patients with consultants from PICU admission to discharge, with 61% attributed to subspecialty input. Forty-five percent of patients with consultations had additional imaging and/or laboratory testing and 55% had a medication change and/or a procedure performed immediately after consultation.
AHRQ-funded; HS026965.
Citation: Ramesh S, Ayres B, Eyck PT .
Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit.
Diagnosis 2022 Aug;9(3):379-84. doi: 10.1515/dx-2021-0137..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality
Doty AM, Rising KL, Hsiao T
"Unfortunately, I don't have an answer for you": how resident physicians communicate diagnostic uncertainty to patients during emergency department discharge.
This study’s objective was to describe how emergency medicine resident physicians discuss diagnostic uncertainty during a simulated emergency department (ED) discharge discussion. Most residents in the simulation explained the evaluation revealed no cause for symptoms, noted concerning diagnoses that were excluded, and acknowledged both symptoms and patients’ feelings. However, 28% of residents did not discuss diagnostic uncertainty in any form. All residents were reassuring. Those who did discuss diagnostic uncertainty used explicit and implicit language with similar frequency.
AHRQ-funded; HS025651.
Citation: Doty AM, Rising KL, Hsiao T .
"Unfortunately, I don't have an answer for you": how resident physicians communicate diagnostic uncertainty to patients during emergency department discharge.
Patient Educ Couns 2022 Jul;105(7):2053-57. doi: 10.1016/j.pec.2021.12.002..
Keywords: Clinician-Patient Communication, Emergency Department, Communication, Diagnostic Safety and Quality
Woods-Hill CZ, Colantuoni EA, Koontz DW
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
The purpose of this AHRQ-funded prospective study was to assess the relationship between a 14-site PICU blood culture collaborative, the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative, and culture rates, antibiotic use, and patient outcomes. The researchers collected data from each participating PICU across the United States and from the Children’s Hospital Association Pediatric Health Information System. The main outcome was blood culture rates, with secondary outcomes including: broad-spectrum antibiotic use and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, readmission, length of stay, sepsis, severe sepsis/septic shock, and mortality. The study found that the blood culture rate preimplementation across the 14 PICUs was 149.4 per 1000 patient days per month, and the rate postimplementation was 100.5 for a 33% relative reduction postimplementation. For those same periods, the rate of antibiotic use decreased from 506 days per 1000 patient-days per month preimplementation to 440 days per 1000 patient-days per month postimplementation, which reflects a 13% relative reduction. Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days per month, a 36% relative reduction. The variables of length of stay, readmission, sepsis, severe sepsis/septic shock, and mortality were similar before and after implementation. The researchers concluded that collaborative interventions can reduce blood culture and antibiotic use in the PICU.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Colantuoni EA, Koontz DW .
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
JAMA Pediatr 2022 Jul;176(7):690-98. doi: 10.1001/jamapediatrics.2022.1024..
Keywords: Children/Adolescents, Sepsis, Critical Care, Antibiotics, Medication, Diagnostic Safety and Quality, Antimicrobial Stewardship
Nelson KE, Chakravarti V, Diskin C
Validation of neurologic impairment diagnosis codes as signifying documented functional impairment in hospitalized children.
This study’s objective was to assess the performance of previously published high-intensity neurologic impairment (NI) diagnosis codes in identification of hospitalized children with clinical NI. This retrospective study of 500 randomly selected discharges in 2019 was conducted at a freestanding children’s hospital. Charts were reviewed for: 1) NI discharge diagnosis codes and 2) documentation of clinical NI (a neurologic diagnosis and indication of functional impairment like medical technology). Diagnosis codes identified clinically documented NI with 88.1% specificity, and 79.4% sensitivity; negative predictive value (NPV) was 96.7%, and positive predictive value (PPV) was 49%. Including children with milder functional impaired results in NPV of 95.7% and PPV of 77.5%. Restriction to children with more severe functional impairment increased NPV and decreased PPV. Misclassification was mostly due to inclusion of children without functional impairments.
AHRQ-funded; HS025138.
Citation: Nelson KE, Chakravarti V, Diskin C .
Validation of neurologic impairment diagnosis codes as signifying documented functional impairment in hospitalized children.
Acad Pediatr 2022 Jul;22(5):782-88. doi: 10.1016/j.acap.2021.07.014..
Keywords: Children/Adolescents, Neurological Disorders, Diagnostic Safety and Quality
McCarthy DM, Formella KT, Ou EZ
There's an app for that: teaching residents to communicate diagnostic uncertainty through a mobile gaming application.
The purpose of this study was to improve doctor-patient communication by assessing the utilization of a mobile application (app) for teaching physician communication skills about diagnostic uncertainty, obtaining feedback on app utilization, and evaluating the association between app use and mastery of skills. Emergency medicine resident physicians were randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty which included a web-based interactive model and an app. Only 31.2% of the 109 participants used the app, with senior residents more likely to use the app than junior residents. Researchers report that of those who used the app, reviews were positive, with 76% indicating the app facilitated their learning. The study found that in the trial there was no significant correlation between the utilization of the app and mastery of the communication skill. The researchers concluded that without mandated use and evidence of effectiveness, apps should not be offered to physicians as an educational option and training opportunity for improving communication skills.
AHRQ-funded; HS025651.
Citation: McCarthy DM, Formella KT, Ou EZ .
There's an app for that: teaching residents to communicate diagnostic uncertainty through a mobile gaming application.
Patient Educ Couns 2022 Jun;105(6):1463-69. doi: 10.1016/j.pec.2021.09.038..
Keywords: Diagnostic Safety and Quality, Clinician-Patient Communication, Communication, Education: Continuing Medical Education, Health Information Technology (HIT)
Giardina TD, Choi DT, Upadhyay DK
Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
This study’s objective was to test if patients can identify concerns about their diagnosis through structured evaluation of their online visit notes in an electronic health record (EHR) system. Patients aged 18-85 years in a large integrated health system who actively used the patient portal were invited to respond to an online questionnaire if an EHR algorithm detected any recent visit following an initial primary care consultation. The authors developed and tested an instrument (Safer Dx Patient Instrument) to help patients identify concerns related to the diagnostic process based on notes review and recall of recent “at-risk” visits. The algorithm identified 1282 eligible patients, of whom 486 responded. Of the 418 patients included in the analysis, 51 patients (12.2%) identified a diagnostic concern. Patients were more likely to report a concern if they disagreed with statements "The care plan the provider developed for me addressed all my medical concerns", "I trust the provider that I saw during my visit" and agreed with the statement "I did not have a good feeling about my visit".
AHRQ-funded; HS027363; HS025474.
Citation: Giardina TD, Choi DT, Upadhyay DK .
Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
J Am Med Inform Assoc 2022 May 11;29(6):1091-100. doi: 10.1093/jamia/ocac036..
Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Experience, Patient Safety
Lowry KP, Bissell MCS, Miglioretti DL
Breast biopsy recommendations and breast cancers diagnosed during the COVID-19 pandemic.
The authors sought to examine breast biopsy recommendations and breast cancers diagnosed before and during the COVID-19 pandemic by mode of detection and women's characteristics. Using data from the Breast Cancer Surveillance Consortium, they found that there were substantially fewer breast biopsies with cancer diagnoses during the COVID-19 pandemic from March to September 2020 compared to the same period in 2019, with Asian and Hispanic women experiencing the largest declines followed by Black women.
AHRQ-funded; HS018366.
Citation: Lowry KP, Bissell MCS, Miglioretti DL .
Breast biopsy recommendations and breast cancers diagnosed during the COVID-19 pandemic.
Radiology 2022 May;303(2):287-94. doi: 10.1148/radiol.2021211808..
Keywords: COVID-19, Cancer: Breast Cancer, Cancer, Diagnostic Safety and Quality
Gupta A, Petty L, Gandhi T
Overdiagnosis of urinary tract infection linked to overdiagnosis of pneumonia: a multihospital cohort study.
This study’s goal was to determine if there is a correlation between overdiagnosis of urinary tract infection (UTI) and overdiagnosis of community-acquired pneumonia (CAP) in hospitals, resulting in unnecessary antibiotic use and diagnostic delays. The authors first determined the proportion of hospitalized patients treated for CAP or UTI at 46 hospitals in Michigan who were overdiagnosed according to national guideline definitions. Then they used Pearson's correlation coefficient to compare hospital proportions of overdiagnosis of CAP and UTI. They included 14,085 patients treated for CAP and 10,398 patients treated for UTI. There was a moderate correlation within hospitals of the proportion of patients overdiagnosed with UTI and those overdiagnosed with CAP.
AHRQ-funded; HS026530.
Citation: Gupta A, Petty L, Gandhi T .
Overdiagnosis of urinary tract infection linked to overdiagnosis of pneumonia: a multihospital cohort study.
BMJ Qual Saf 2022 May;31(5):383-86. doi: 10.1136/bmjqs-2021-013565..
Keywords: Urinary Tract Infection (UTI), Pneumonia, Community-Acquired Infections, Diagnostic Safety and Quality
Miller AC, Arakkal AT, Koeneman SH
Frequency and duration of, and risk factors for, diagnostic delays associated with histoplasmosis.
This study’s goal was to estimate the incidence, length of, and risk factors for diagnostic delays associated with histoplasmosis. The authors used data from IBM Marketscan from 2001 to 2017 to find all patients diagnosed with histoplasmosis. They calculated the number of visits prior to diagnosis, and the number of visits with symptomatically similar diagnoses (SSDs). Using a simulation-based approach, they estimated the number of visits that represented a delay, computed the number of potential opportunities for diagnosis that were missed for each patient, and computed the length time to the final diagnosis. The number of SSD-related visits increased significantly in the 97 days prior to diagnosis. The authors found that 97.4% of patients had a visit, and 90.1% had at least one SSD visit. They estimated that 82.9% of patients with histoplasmosis experienced at least one missed diagnostic opportunity. The average diagnosis delay was 39.5 days with an average of 4.0 missed opportunities. Risk factors for missed diagnosis included prior antibiotic use, history of other pulmonary diseases, and emergency department and outpatient visits, especially during weekends.
AHRQ-funded; HS027375.
Citation: Miller AC, Arakkal AT, Koeneman SH .
Frequency and duration of, and risk factors for, diagnostic delays associated with histoplasmosis.
J Fungi 2022 Apr 23;8(5). doi: 10.3390/jof8050438..
Keywords: Diagnostic Safety and Quality
Starnes LS, Krehnbrink M, Carroll AR
A pain in the neck: an adolescent with neck pain.
This case study involves a 15-year-old boy who presents with several years of intermittent neck pain, which has acutely worsened during the past 4 days. Patient history, diagnosis (Salmonella osteomyelitis.), and treatment are explored.
AHRQ-funded; HS026122.
Citation: Starnes LS, Krehnbrink M, Carroll AR .
A pain in the neck: an adolescent with neck pain.
Pediatr Rev 2022 Mar;43(3):174-77. doi: 10.1542/pir.2020-004168..
Keywords: Children/Adolescents, Infectious Diseases, Diagnostic Safety and Quality, Case Study, Evidence-Based Practice
Woloshin S, Dewitt B, Krishnamurti T
Assessing how consumers interpret and act on results from at-home COVID-19 self-test kits: a randomized clinical trial.
The US Food and Drug Administration (FDA) authorized SARS-CoV-2 rapid at-home self-test kits for individuals with and without symptoms. How appropriately users interpret and act on the results of at-home COVID-19 self-tests is unknown. The objective of this study was to assess how users of at-home COVID-19 self-test kits interpreted and acted on results when given instructions authorized by the FDA, instructions based on decision science principles, or no instructions.
AHRQ-funded; HS024075.
Citation: Woloshin S, Dewitt B, Krishnamurti T .
Assessing how consumers interpret and act on results from at-home COVID-19 self-test kits: a randomized clinical trial.
JAMA Intern Med 2022 Mar;182(3):332-41. doi: 10.1001/jamainternmed.2021.8075..
Keywords: COVID-19, Diagnostic Safety and Quality
Lacson R, Khorasani R, Fiumara K
Collaborative case review: a systems-based approach to patient safety event investigation and analysis.
The objectives of this study were to assess a system-based approach to event investigation and analysis--collaborative case reviews (CCRs)--and to measure impact of clinical specialty on strength of action items prescribed. The institutional review board-approved study describes the program, including a percentage of CCR from an institutional Electronic Safety Reporting System. Findings showed that an integrated multispecialty CCR co-led by the radiology department and an institutional patient safety program was associated with a higher proportion of CCR, stronger action items, and higher action item completion rate versus other hospital departments.
AHRQ-funded; HS024722.
Citation: Lacson R, Khorasani R, Fiumara K .
Collaborative case review: a systems-based approach to patient safety event investigation and analysis.
J Patient Saf 2022 Mar 1;18(2):e522-e27. doi: 10.1097/pts.0000000000000857..
Keywords: Patient Safety, Adverse Events, Diagnostic Safety and Quality, Imaging
Hua CL, Thomas KS, Bunker JN
Dementia diagnosis in the hospital and outcomes among patients with advanced dementia documented in the Minimum Data Set.
This retrospective cohort study examined the association between a dementia diagnosis listed on a hospital claim and patient outcomes among individuals with a Minimum Data Set (MDS) assessment. The cohort was comprised of hospitalized patients aged 66 years and older with advanced dementia noted on an MDS assessment completed within 120 days prior to their first hospitalization in 2017. Among 120,989 patients with advanced dementia and a nursing home stay, 90.6% had a dementia diagnosis on their hospital claims. Documentation of a dementia diagnosis was associated with lower use of intensive care unit or coronary care unit, use of invasive mechanical ventilation, and 30-day mortality. These patients also had a shorter hospital length of stay.
AHRQ-funded; HS000011.
Citation: Hua CL, Thomas KS, Bunker JN .
Dementia diagnosis in the hospital and outcomes among patients with advanced dementia documented in the Minimum Data Set.
J Am Geriatr Soc 2022 Mar;70(3):846-53. doi: 10.1111/jgs.17564..
Keywords: Dementia, Diagnostic Safety and Quality, Medicare, Hospitals, Neurological Disorders
Marshall TL, Rinke ML, Olson APJ
Diagnostic error in pediatrics: a narrative review.
This narrative review focuses on the relative paucity of large, high-quality studies of diagnostic errors and what is known at present about the incident and epidemiology as well as the established research for identifying, evaluating, and reducing diagnostic errors. The authors propose several key research questions aimed at addressing persistent gaps in the pediatric diagnostic error literature. The authors state that additional research is needed to better establish the epidemiology of diagnostic errors in pediatrics, including identifying high-risk clinical scenarios, patient populations, and groups of diagnoses.
AHRQ-funded; HS023827; HS026644.
Citation: Marshall TL, Rinke ML, Olson APJ .
Diagnostic error in pediatrics: a narrative review.
Pediatrics 2022 Mar;149(Suppl 3). doi: 10.1542/peds.2020-045948D..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Patient Safety, Medical Errors
Radhakrishnan A, Reyes-Gastelum D, Abrahamse P
Physician specialties involved in thyroid cancer diagnosis and treatment: implications for improving health care disparities.
The authors sought to characterize providers involved in diagnosing and treating thyroid cancer. Patients with differentiated thyroid cancer from the Georgia and Los Angeles County Surveillance, Epidemiology and End Results registries were surveyed. The authors found that, among thyroid cancer patients, 40.6% reported being informed of their diagnosis by their surgeon, 37.9% by their endocrinologist, and 13.5% by their primary care physician (PCP). The researchers concluded that PCPs were involved in thyroid cancer diagnosis and treatment, and their involvement was greater among older patients and patients of minority race/ethnicity.
AHRQ-funded; HS024512.
Citation: Radhakrishnan A, Reyes-Gastelum D, Abrahamse P .
Physician specialties involved in thyroid cancer diagnosis and treatment: implications for improving health care disparities.
J Clin Endocrinol Metab 2022 Feb 17;107(3):e1096-e105. doi: 10.1210/clinem/dgab781..
Keywords: Cancer, Disparities, Diagnostic Safety and Quality, Practice Patterns, Quality Improvement, Quality of Care
Vivtcharenko VY, Ramesh S, Dukes K
Diagnosis documentation of critically ill children at admission to a PICU.
This study’s objective was to describe how pediatric critical care clinicians document patients' diagnoses at PICU admission. PICU admission notes for 96 unique patients were reviewed. Findings showed that most PICU admission notes documented a rationale for the primary diagnosis and expressed diagnostic uncertainty. Clinicians varied widely in how they organized diagnostic information, used contextual details to clarify the diagnosis, and expressed uncertainty. Recommendations included future work to determine how diagnosis narratives affect clinical decision-making, patient care, and outcomes.
AHRQ-funded; HS026965; HS022087.
Citation: Vivtcharenko VY, Ramesh S, Dukes K .
Diagnosis documentation of critically ill children at admission to a PICU.
Pediatr Crit Care Med 2022 Feb;23(2):99-108. doi: 10.1097/pcc.0000000000002812..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Diagnostic Safety and Quality
