New Tool Helps Identify Diagnostic Errors in Primary Care, AHRQ Study Finds

An AHRQ-funded study resulted in the development of a successful tool, called the “Safer Dx Instrument,” to measure diagnostic errors in primary care settings. Diagnostic errors are defined as missed opportunities to make a correct or timely diagnosis based on the evidence, regardless of patient harm. After creating a tool with 12 elements, the researchers tested it for accuracy against 389 patient records, some of which had previously been identified as having diagnostic errors. The Safer Dx Instrument had a reasonably high accuracy and predictive value to detect the presence or absence of diagnostic error. The study’s authors concluded that this instrument could be useful to identify high-risk cases for further study and quality improvement. Because of its reduced reliance on subjectivity, the authors said that the Safer Dx Instrument could serve as a standard for assessing a wide spectrum of diagnostic process breakdowns. The researchers emphasized that the Safer Dx Instrument is a much-needed first step in analyzing diagnostic processes in the primary care setting through comprehensive record review. “Accuracy of the Safer Dx Instrument to Identify Diagnostic Errors in Primary Care” appeared in the Journal of General Internal Medicine. Access the abstract.

2016 Feb 22. [Epub ahead of print]

Accuracy of the Safer Dx Instrument to Identify Diagnostic Errors in Primary Care.

Al-Mutairi A1,2, Meyer AN1, Thomas EJ3,4, Etchegaray JM4,5, Roy KM6, Davalos MC6, Sheikh S7, Singh H8.

Author information

Abstract

IMPORTANCE:

Diagnostic errors are common and harmful, but difficult to define and measure. Measurement of diagnostic errors often depends on retrospective medical record reviews, frequently resulting in reviewer disagreement.

OBJECTIVES:

We aimed to test the accuracy of an instrument to help detect presence or absence of diagnostic error through record reviews.

DESIGN:

We gathered questions from several previously used instruments for diagnostic error measurement, then developed and refined ourinstrument. We tested the accuracy of the instrument against a sample of patient records (n = 389), with and without previously identifieddiagnostic errors (n = 129 and n = 260, respectively).

RESULTS:

The final version of our instrument (titled Safer Dx Instrument) consisted of 11 questions assessing diagnostic processes in the patient-provider encounter and a main outcome question to determine diagnostic error. In comparison with the previous sample, the instrumentyielded an overall accuracy of 84 %, sensitivity of 71 %, specificity of 90 %, negative predictive value of 86 %, and positive predictive value of 78 %. All 11 items correlated significantly with the instrument's error outcome question (all p values ≤ 0.01). Using factor analysis, the 11 questions clustered into two domains with high internal consistency (initial diagnostic assessment, and performance and interpretation ofdiagnostic tests) and a patient factor domain with low internal consistency (Cronbach's alpha coefficients 0.93, 0.92, and 0.38, respectively).

CONCLUSIONS:

The Safer Dx Instrument helps quantify the likelihood of diagnostic error in primary care visits, achieving a high degree ofaccuracy for measuring their presence or absence. This instrument could be useful to identify high-risk cases for further study and quality improvement.