Tracking Progress in Improving Diagnosis: A Framework for Defining Undesirable Diagnostic Events

Andrew P.J. Olson, Mark L. Graber, Hardeep Singh

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Diagnostic error is a prevalent, harmful, and costly phenomenon. Multiple national health care and governmental organizations have recently identified the need to improve diagnostic safety as a high priority. A major barrier, however, is the lack of standardized, reliable methods for measuring diagnostic safety. Given the absence of reliable and valid measures for diagnostic errors, we need methods to help establish some type of baseline diagnostic performance across health systems, as well as to enable researchers and health systems to determine the impact of interventions for improving the diagnostic process. Multiple approaches have been suggested but none widely adopted. We propose a new framework for identifying “undesirable diagnostic events” (UDEs) that health systems, professional organizations, and researchers could further define and develop to enable standardized measurement and reporting related to diagnostic safety. We propose an outline for UDEs that identifies both conditions prone to diagnostic error and the contexts of care in which these errors are likely to occur. Refinement and adoption of this framework across health systems can facilitate standardized measurement and reporting of diagnostic safety.

Original languageEnglish (US)
Pages (from-to)1187-1191
Number of pages5
JournalJournal of general internal medicine
Issue number7
StatePublished - Jul 1 2018

Bibliographical note

Funding Information:
Funding Dr. Singh is supported by the VA Health Services Research and Development Service (CRE 12–033; Presidential Early Career Award for Scientists and Engineers USA 14–274), the VA National Center for Patient Safety, the Agency for Health Care Research and Quality (R01HS022087 and R21HS023602), and the Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413).

Publisher Copyright:
© 2018, Society of General Internal Medicine (outside the USA).


  • diagnosis
  • diagnostic error
  • measurement
  • patient safety


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