Diagnostic Discordance, Health Information Exchange, and Inter-Hospital Transfer Outcomes: a Population Study.

ABSTRACT: BACKGROUND:Studying diagnostic error at the population level requires an understanding of how diagnoses change over time. OBJECTIVE:To use inter-hospital transfers to examine the frequency and impact of changes in diagnosis on patient risk, and whether health information exchange can improve patient safety by enhancing diagnostic accuracy. DESIGN:Diagnosis coding before and after hospital transfer was merged with responses from the American Hospital Association Annual Survey for a cohort of patients transferred between hospitals to identify predictors of mortality. PARTICIPANTS:Patients (180,337) 18 years or older transferred between 473 acute care hospitals from NY, FL, IA, UT, and VT from 2011 to 2013. MAIN MEASURES:We identified discordant Elixhauser comorbidities before and after transfer to determine the frequency and developed a weighted score of diagnostic discordance to predict mortality. This was included in a multivariate model with inpatient mortality as the dependent variable. We investigated whether health information exchange (HIE) functionality adoption as reported by hospitals improved diagnostic discordance and inpatient mortality. KEY RESULTS:Discordance in diagnoses occurred in 85.5% of all patients. Seventy-three percent of patients gained a new diagnosis following transfer while 47% of patients lost a diagnosis. Diagnostic discordance was associated with increased adjusted inpatient mortality (OR 1.11 95% CI 1.10-1.11, p?

SUBMITTER: Usher M 

PROVIDER: S-EPMC6109004 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature