Dataset Information

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

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 our instrument. We tested the accuracy of the instrument against a sample of patient records (n?=?389), with and without previously identified diagnostic 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 instrument yielded 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 of diagnostic 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 of accuracy for measuring their presence or absence. This instrument could be useful to identify high-risk cases for further study and quality improvement.

SUBMITTER: Al-Mutairi A

PROVIDER: S-EPMC4870415 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Publications

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

Al-Mutairi Aymer A Meyer Ashley N D AN Thomas Eric J EJ Etchegaray Jason M JM Roy Kevin M KM Davalos Maria Caridad MC Sheikh Shazia S Singh Hardeep H

Journal of general internal medicine 20160222 6

<h4>Importance</h4>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.<h4>Objectives</h4>We aimed to test the accuracy of an instrument to help detect presence or absence of diagnostic error through record reviews.<h4>Design</h4>We gathered questions from several previously used instruments for diagnostic error measurement, then develop ...[more]

PMID: 26902245

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Project description:ObjectiveTo quantify the predictive value of unexpected weight loss (WL) for cancer according to patient's age, sex, smoking status, and concurrent clinical features (symptoms, signs, and abnormal blood test results).DesignDiagnostic accuracy study.SettingClinical Practice Research Datalink electronic health records data linked to the National Cancer Registration and Analysis Service in primary care, England.Participants63 973 adults (≥18 years) with a code for unexpected WL from 1 January 2000 to 31 December 2012.Main outcome measuresCancer diagnosis in the six months after the earliest weight loss code (index date). Codes for additional clinical features were identified in the three months before to one month after the index date. Diagnostic accuracy measures included positive and negative likelihood ratios, positive predictive values, and diagnostic odds ratios.ResultsOf 63 973 adults with unexpected WL, 37 215 (58.2%) were women, 33 167 (51.8%) were aged 60 years or older, and 16 793 (26.3%) were ever smokers. 908 (1.4%) had a diagnosis of cancer within six months of the index date, of whom 882 (97.1%) were aged 50 years or older. The positive predictive value for cancer was above the 3% threshold recommended by the National Institute for Health and Care Excellence for urgent investigation in male ever smokers aged 50 years or older, but not in women at any age. 10 additional clinical features were associated with cancer in men with unexpected WL, and 11 in women. Positive likelihood ratios in men ranged from 1.86 (95% confidence interval 1.32 to 2.62) for non-cardiac chest pain to 6.10 (3.44 to 10.79) for abdominal mass, and in women from 1.62 (1.15 to 2.29) for back pain to 20.9 (10.7 to 40.9) for jaundice. Abnormal blood test results associated with cancer included low albumin levels (4.67, 4.14 to 5.27) and raised values for platelets (4.57, 3.88 to 5.38), calcium (4.28, 3.05 to 6.02), total white cell count (3.76, 3.30 to 4.28), and C reactive protein (3.59, 3.31 to 3.89). However, no normal blood test result in isolation ruled out cancer. Clinical features co-occurring with unexpected WL were associated with multiple cancer sites.ConclusionThe risk of cancer in adults with unexpected WL presenting to primary care is 2% or less and does not merit investigation under current UK guidelines. However, in male ever smokers aged 50 years or older and in patients with concurrent clinical features, the risk of cancer warrants referral for invasive investigation. Clinical features typically associated with specific cancer sites are markers of several cancer types when they occur with unexpected WL.

Dataset Information

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

Importance

Objectives

Design

Results

Conclusions

Publications

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

Similar Datasets

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