Diagnostic errors are a source of unacceptable harm in health care. However, improvement efforts have been hampered by the lack of valid measures reflecting the quality of the diagnostic process. At the same time, it has become apparent that the healthcare work system, particularly in primary care, is chaotic and stressful, leading to clinician burnout and patient harm. We propose a new construct that health systems and researchers can use to measure the quality and safety of the diagnostic process that is sensitive to the context of the health care work system. This model focuses on three measurable practices: considering “don’t miss” diagnoses, looking for red flags, and ensuring that clinicians avoid common diagnostic pitfalls. We believe that the performance of clinicians with respect to these factors is sensitive to the health care work system, allowing for context-dependent measurement and improvement of the diagnostic process. Such process measures will enable more rapid improvements rather than exclusively measuring outcomes related to “correct” or “incorrect” diagnoses.
Bibliographical noteFunding Information:
Dr. Olson is supported by the Alliance for Academic Internal Medicine, CRICO (Harvard Risk Management Foundation), and the Gordon and Betty Moore Foundation for work focused on improving diagnostic safety. Dr. Schiff acknowledges the support of the Gordon and Betty Moore Foundation and CRICO (Harvard Risk Management Foundation) for diagnostic safety work. Dr. Linzer is supported by CRICO (Harvard Risk Management Foundation) for diagnostic safety work, and also by the American Medical Association, American College of Physicians, the Institute for Healthcare Improvement, and the American Board of Internal Medicine Foundation for burnout prevention research and training.
© 2021, Society of General Internal Medicine.
Copyright 2021 Elsevier B.V., All rights reserved.
PubMed: MeSH publication types