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Search All Research Studies
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- Adverse Events (2)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 9 of 9 Research Studies DisplayedBell SK, Dong ZJ, Desroches CM
Partnering with patients and families living with chronic conditions to coproduce diagnostic safety through OurDX: a previsit online engagement tool.
Involving patients and their families in the diagnostic process is crucial, but there is a lack of methods for consistent engagement. The implementation of policies providing patients with access to electronic health records offers new possibilities. The researchers evaluated a novel online tool ("OurDX"), co-created with patients and families, to examine the nature and frequency of potential safety issues identified by patients and their families with chronic health conditions and whether these insights were incorporated into visit notes. At two US healthcare facilities, patients and their families were encouraged to participate via an online pre-visit questionnaire, which covered: (1) visit priorities, (2) recent medical history and symptoms, and (3) potential diagnostic concerns. Two physicians assessed patient-reported diagnostic issues to validate and classify diagnostic safety opportunities (DSOs). The researchers performed a chart review to determine if patient inputs were integrated into the visit note. Descriptive statistics were employed to report implementation outcomes, DSO verification, and chart review findings. The study found that OurDX reports were completed in 7075 of 18,129 (39%) eligible pediatric subspecialty visits (site 1) and 460 of 706 (65%) eligible adult primary care visits (site 2). Of the patients expressing diagnostic concerns, 63% were confirmed as probable DSOs. Overall, 7.5% of pediatric and adult patients and their families with chronic health conditions identified probable DSOs. The most frequent DSO types included patients and families feeling unheard; issues or delays in tests or referrals; and complications or delays in clarification or subsequent steps. The chart review revealed that most clinician notes incorporated all or some of the patient or family priorities and patient-reported histories.
AHRQ-funded; HS027367
Citation: Bell SK, Dong ZJ, Desroches CM .
Partnering with patients and families living with chronic conditions to coproduce diagnostic safety through OurDX: a previsit online engagement tool.
J Am Med Inform Assoc 2023 Mar 16;30(4):692-702. doi: 10.1093/jamia/ocad003.
Keywords: Chronic Conditions, Diagnostic Safety and Quality, Health Information Technology (HIT), Patient and Family Engagement, Healthcare Delivery
Giardina TD, Hunte H, Hill MA
Defining diagnostic error: a scoping review to assess the impact of the National Academies' report improving diagnosis in Health Care.
This study looked at peer-reviewed published literature to explore how researchers operationalize the National Academies of Science, Engineering, and Medicine’s (NASEM) definition of diagnostic error that was defined in their 2015 publication “Improving Diagnosis in Health Care”. Published literature was identified from October 2015 to February 2021. The authors also conducted subject matter expert interviews. Of the 34 studies identified, 16 were analyzed and abstracted to determine how diagnostic error was operationalized and measured. Studies were grouped by four themes: epidemiology, patient focus, measurement/surveillance, and clinician focus. Nine studies identified used the NASM definition. Five of those studies also operationalized with existing definitions proposed before the NASEM report, four operationalized the components of the NASEM definition, and three studies operationalized error using existing definitions only. Subject matter experts concluded that the NASEM definition functions as a foundation for researchers to conceptualize diagnostic error.
AHRQ-funded; 233201500022I; HS027280; HS025474; HS027363.
Citation: Giardina TD, Hunte H, Hill MA .
Defining diagnostic error: a scoping review to assess the impact of the National Academies' report improving diagnosis in Health Care.
J Patient Saf 2022 Dec 1;18(8):770-78. doi: 10.1097/pts.0000000000000999..
Keywords: Diagnostic Safety and Quality, Quality of Care, Medical Errors, Adverse Events, Healthcare Delivery
Singh H, Graber ML, Hofer TP
Measures to improve diagnostic safety in clinical practice.
In this paper, the investigators discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. They highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, they propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined.
AHRQ-funded; HS022087.
Citation: Singh H, Graber ML, Hofer TP .
Measures to improve diagnostic safety in clinical practice.
J Patient Saf 2019 Dec;15(4):311-16. doi: 10.1097/pts.0000000000000338.
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Keywords: Patient Safety, Diagnostic Safety and Quality, Healthcare Delivery, Quality Improvement, Quality of Care, Medical Errors, Adverse Events
Danforth KN, Hahn EE, Slezak JM
Follow-up of abnormal estimated GFR results within a large integrated health care delivery system: a mixed-methods study.
This study examined the rates of follow-up with patients after abnormal estimated glomular filtration rate (eGFR) laboratory results, which may indicate chronic kidney disease. A large integrated health system was used with a total of 244,540 patients aged 21 or older with abnormal eGFRs were included from January 2010 through December 2015. Timely follow-up was defined as repeat eGFR testing within 60 to 150 days, follow-up testing before 60 days that indicated normal kidney function, or diagnosis before 60 days of chronic kidney disease or kidney cancer. Follow-up was found to be poor, with 58% of patients lacking timely follow-up. Fifteen physicians were also interviewed and it was found that both system-level and provider-level factors influenced follow-up rates.
AHRQ-funded; HS024437.
Citation: Danforth KN, Hahn EE, Slezak JM .
Follow-up of abnormal estimated GFR results within a large integrated health care delivery system: a mixed-methods study.
Am J Kidney Dis 2019 Nov;74(5):589-600. doi: 10.1053/j.ajkd.2019.05.003..
Keywords: Healthcare Delivery, Diagnostic Safety and Quality, Kidney Disease and Health, Electronic Health Records (EHRs), Health Information Technology (HIT), Chronic Conditions
Gupta A, Harrod M, Quinn M
Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors.
This study focused on how system problems within two academic institutions contribute to cognitive and diagnostic errors of inpatient physicians. Observations were conducted by physicians, nurses, and non-clinicians (qualitative researchers, social scientists and health care engineers). Focus groups were also conducted. System-based problems included interruptions, time constraints and physical space.
AHRQ-funded; HS024385; HS022835; HS022087.
Citation: Gupta A, Harrod M, Quinn M .
Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors.
Diagnosis 2018 Sep 25;5(3):151-56. doi: 10.1515/dx-2018-0014..
Keywords: Diagnostic Safety and Quality, Quality of Care, Healthcare Delivery, Inpatient Care, Medical Errors
Bhise V, Rajan SS, Sittig DF
Defining and measuring diagnostic uncertainty in medicine: a systematic review.
In this paper, the authors conducted a systematic review to describe how diagnostic uncertainty is defined and measured in medical practice. The authors concluded that the term "diagnostic uncertainty" lacked a clear definition, and there was no comprehensive framework for its measurement in medical practice. Based on their review findings, they propose that diagnostic uncertainty be defined as a "subjective perception of an inability to provide an accurate explanation of the patient's health problem."
AHRQ-funded; HS022087; HS023602.
Citation: Bhise V, Rajan SS, Sittig DF .
Defining and measuring diagnostic uncertainty in medicine: a systematic review.
J Gen Intern Med 2018 Jan;33(1):103-15. doi: 10.1007/s11606-017-4164-1..
Keywords: Decision Making, Diagnostic Safety and Quality, Healthcare Delivery
Bello JK, Mohanty N, Bauer V
Pediatric hypertension: provider perspectives.
The researchers aimed to gain insights into reasons for low rates of diagnosis and treatment from primary care providers. In interviews, providers reflected on numerous barriers to diagnosis, management, and follow-up; recommendations for educational content; and how community health center systems can be improved. Findings informed development of a multifaceted intervention.
AHRQ-funded; HS024100.
Citation: Bello JK, Mohanty N, Bauer V .
Pediatric hypertension: provider perspectives.
Glob Pediatr Health 2017 Jun 6;4:2333794x17712637. doi: 10.1177/2333794x17712637.
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Keywords: Children/Adolescents, Diagnostic Safety and Quality, Healthcare Delivery, Blood Pressure, Obesity, Primary Care
Hodell E, Hughes SD, Corry M
Paramedic perspectives on barriers to prehospital acute stroke recognition.
The researchers aimed to understand systematically the challenges and barriers faced by paramedics in recognizing stroke presentations in the field. They concluded that while challenges to stroke recognition in the field were slightly different for rural and urban emergency medical service providers, participants concurred that timely, systematic feedback on individual patients and case-based training would strengthen early stroke recognition skills.
AHRQ-funded; HS017965.
Citation: Hodell E, Hughes SD, Corry M .
Paramedic perspectives on barriers to prehospital acute stroke recognition.
Prehosp Emerg Care 2016 May-Jun;20(3):415-24. doi: 10.3109/10903127.2015.1115933.
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Keywords: Diagnostic Safety and Quality, Emergency Medical Services (EMS), Healthcare Delivery, Stroke, Training
Bares S, Eavou R, Bertozzi-Villa C
Expanded HIV testing and linkage to care: Conventional vs. Point-of-care testing and assignment of patient notification and linkage to care to an HIV care program.
This study examined the X-TLC program that used standard blood-based laboratory testing vs. point-of-care rapid testing or rapid laboratory testing with point-of-care results notification. Site coordinators and the linkage-to-care coordinator oversaw testing, test notification, and linkage to care. It concluded that HIV screening and linkage to care can be accomplished by incorporating standard testing for HIV into routine medical care.
AHRQ-funded; HS022433.
Citation: Bares S, Eavou R, Bertozzi-Villa C .
Expanded HIV testing and linkage to care: Conventional vs. Point-of-care testing and assignment of patient notification and linkage to care to an HIV care program.
Public Health Rep 2016 Jan-Feb;131 Suppl 1:107-20.
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Keywords: Healthcare Delivery, Diagnostic Safety and Quality, Human Immunodeficiency Virus (HIV), Urban Health, Vulnerable Populations