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AHRQ Research Studies
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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.
Results1 to 25 of 508 Research Studies Displayed
Acharya C, Shaw J, Duong N
QuickStroop, a shortened version of EncephalApp, detects covert hepatic Encephalopathy with similar accuracy within one minute.
This study sought to determine whether QuickStroop, a shortened version of EncephalApp, can detect covert hepatic encephalopathy (CHE) as accurately and quickly as psychometric hepatic encephalopathy score (PHES), the gold standard for CHE testing. Data was analyzed for a total of 398 individual runs versus total EncephalApp time versus PHES-CHE split into training (n = 299) and test (n = 99) sets. The validation cohort showed an accuracy of 84% to diagnose PHES-CHE. Time for CHE diagnosis decreased from 203.7 to 36.8 seconds in the derivation and from 178.2 to 32.9 seconds in the validation cohort.
Citation: Acharya C, Shaw J, Duong N . QuickStroop, a shortened version of EncephalApp, detects covert hepatic Encephalopathy with similar accuracy within one minute. Clin Gastroenterol Hepatol 2023 Jan;21(1):136-42. doi: 10.1016/j.cgh.2021.12.047..
Keywords: Diagnostic Safety and Quality
Peng L, Luo G, Walker A
Evaluation of federated learning variations for COVID-19 diagnosis using chest radiographs from 42 US and European hospitals.
The goals of this study were to compare a single-site, COVID-19 computer diagnosis system that used the Federated Averaging (FedAvg) algorithm with 3-client Federated learning (FL) models, and to evaluate the performance of the four FL variations. Researchers leveraged a FL healthcare collaborative that included data from five US and European healthcare systems encompassing 42 hospitals. They concluded that FedAvg could significantly improve generalization of the model in comparison with other personalization FL algorithms--FedProx, FedBN, and FedAMP--but at the cost of poor internal validity.
Citation: Peng L, Luo G, Walker A . Evaluation of federated learning variations for COVID-19 diagnosis using chest radiographs from 42 US and European hospitals. J Am Med Inform Assoc 2022 Dec 13;30(1):54-63. doi: 10.1093/jamia/ocac188..
Keywords: COVID-19, Diagnostic Safety and Quality, Imaging, Hospitals
Rosen A, Carter D, Applebaum JR
Critical care clinicians' experiences of patient safety during the COVID-19 pandemic.
The purpose of this mixed methods, multi-institutional study was to explore how the COVID-19 pandemic worsened preexisting issues of patient safety and created new challenges for patient safety within United States intensive care units (ICU.) The researchers conducted a national survey of critical care clinicians to assess their experiences related to patient safety during the pandemic. The survey instrument was distributed via email through the Society of Critical Care Medicine listserv, with results reported as percentages while free-text responses were analyzed and coded for themes. The study found that of the 355 survey responses received, 61% believed that conditions during the pandemic were more hazardous when compared with the period prior to the pandemic. When compared with providers who cared for mostly non-COVID-19 or no COVID-19 patients, the professionals who cared for primarily COVID-19 patients had an increased likelihood of perceiving that care was more hazardous. In the coded free-text responses, providers identified themes in patient safety risks including ventilator-related lung injury, medication and diagnostic errors, oversedation, oxygen device removal, and falls. The study concluded that higher levels of COVID-19 case burden were significantly related with perceptions of a less safe patient care environment by frontline ICU clinicians, and further identified specific hazards in intensive care units.
Citation: Rosen A, Carter D, Applebaum JR . Critical care clinicians' experiences of patient safety during the COVID-19 pandemic. J Patient Saf 2022 Dec 1;18(8):e1219-e25. doi: 10.1097/pts.0000000000001060..
Keywords: COVID-19, Patient Safety, Critical Care, Intensive Care Unit (ICU)
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
Bell SK, Bourgeois F, Dong J
Patient identification of diagnostic safety blindspots and participation in "good catches" through shared visit notes.
The goal of this study was to investigate whether sharing clinical notes with patients supported identification of potential breakdowns in the diagnostic process that might be difficult for clinical staff to observe -- "diagnostic safety blindspots." Researchers analyzed patient-reported ambulatory documentation errors among patients at 3 U.S. healthcare centers. Older, female, unemployed, disabled, or sicker patients, or patients who worked in healthcare, were more likely to identify blindspots; patients who self-identified as Black, Asian, multiple races and those with less formal education as well as those who deferred decision-making to their providers were less likely to report blindspots. The researchers concluded that patients who read notes have unique insight about potential errors in their medical records and that organizations should encourage patient review of notes and create systems to track patient-reported blindspots.
Citation: Bell SK, Bourgeois F, Dong J . Patient identification of diagnostic safety blindspots and participation in "good catches" through shared visit notes. Milbank Q 2022 Dec; 100(4):1121-65. doi: 10.1111/1468-0009.12593..
Keywords: Diagnostic Safety and Quality, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Ganeshan S, Pierce L, Mourad M
Impact of patient portal-based self-scheduling of diagnostic imaging studies on health disparities.
The purpose of this study was to explore the impact of self-scheduling on equitable access to care. The researchers utilized an electronic health record patient portal at the University of California San Francisco which deployed a self-scheduling tool allowing patients to self-schedule diagnostic imaging studies. The study found that among all patient portal users, Latinx, Black/African American, and non-English speaking patients, as well as patients with Medi-Cal, California's Medicaid program, and Medicare insurance were less likely to self-schedule studies. were all less likely to self-schedule when compared with commercially insured patients.
Citation: Ganeshan S, Pierce L, Mourad M . Impact of patient portal-based self-scheduling of diagnostic imaging studies on health disparities. J Am Med Inform Assoc 2022 Nov 14;29(12):2096-100. doi: 10.1093/jamia/ocac152..
Keywords: Disparities, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
Malik MA, Motta-Calderon D, Piniella N
A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts.
The purpose of this study was to examine a structured electronic health record (EHR) case review process to identify diagnostic errors (DE) and diagnostic process failures (DPFs) in acute care. The researchers created two test cohorts of all preventable cases (n=28) and an equal number of randomly sampled non-preventable cases (n=28) from 365 adult general medicine patients who expired and were part of the mortality case review process at the research institution. Twenty-seven preventable and 24 non-preventable cases were included in the review process. The study found that the frequency of DE contributing to death was significantly higher for the preventable cohort compared to the non-preventable cohort. The researchers concluded that substantial agreement was observed among final consensus and expert panel reviews using their structured EHR case review process, and DEs contributing to death associated with DPFs were identified in institutionally designated preventable and non-preventable cases.
Citation: Malik MA, Motta-Calderon D, Piniella N . A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts. Diagnosis 2022 Nov;9(4):446-57. doi: 10.1515/dx-2022-0032..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality, Medical Errors
Hickey 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.
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.
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.
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.
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%.
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
AHRQ Author: 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.
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
AHRQ Author: DiStabile P, Timashenka A, Jalal H, and Brady PJ
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.
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.
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.
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.
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
Sun J, Peng L, Li T
Performance of a chest radiograph AI diagnostic tool for COVID-19: a prospective observational study.
The purpose of this observational study was to evaluate the real-time performance of an interpretable artificial intelligence (AI) model to detect COVID-19 on chest radiographs. The researchers utilized 95,363 chest radiographs for model training, external validation, and real-time validation. There were 5,335 real-time predictions and a COVID-19 prevalence of 4.8%. The study found that participants positive for COVID-19 had higher COVID-19 diagnostic scores than participants negative for COVID-19. Real-time model performance remained the same during the 19 weeks of implementation. Model sensitivity was higher in men than in women, but model specificity was higher in women. Sensitivity was higher for Asian and Black participants compared with White participants. The COVID-19 AI diagnostic system had worse accuracy compared with radiologist predictions. The researchers concluded that AI tools underperform when compared with radiologist results.
Citation: Sun J, Peng L, Li T . Performance of a chest radiograph AI diagnostic tool for COVID-19: a prospective observational study. Radiol Artif Intell 2022 Jul;4(4):e210217. doi: 10.1148/ryai.210217..
Keywords: COVID-19, Imaging, Diagnostic Safety and Quality, Health Information Technology (HIT)
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.
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.
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.
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.
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