Evaluation of outcomes from a national patient-initiated second-opinion program.
BACKGROUND
We examined outcomes of patient-initiated second opinions provided by a national second-opinion program.


METHODS
We independently examined data collected from January 1, 2011 to December 31, 2012 from a second-opinion program (Best Doctors, Inc.) that allows employee-beneficiaries to request free second opinions. Clinical intake included ascertaining why patients sought second opinions and acquiring patients' complete medical records. Trained physicians summarized the cases; identified key, unresolved clinical questions; and forwarded the cases to expert specialists who provided independent assessments and recommendations. Second opinions were discussed with and returned to patients for review with their physicians. Nurses determined whether second opinions confirmed, clarified, or changed initial diagnoses and treatments, and physicians estimated their clinical impact. Patient satisfaction also was surveyed.


RESULTS
A total of 6791 patient-initiated second opinions were completed across medical specialties. Patients primarily sought second opinions for help choosing treatment options (41.3%) and for diagnostic concerns (34.8%). Second opinions often resulted in changes in diagnosis (14.8%), treatment (37.4%), or changes in both (10.6%). Clinical impact was estimated as moderate/major in 20.9% of cases for diagnosis and 30.7% of cases for treatment. Changes in diagnoses and/or treatments and clinical impact varied across medical specialties. In patients surveyed (n = 2683), most (94.7%) were satisfied with the experience, but fewer (61.2%) planned to follow the recommendations.


CONCLUSIONS
Patient-initiated second opinions led to recommended changes in diagnosis for about 15% and in treatment for about 37% of participants. Further evaluation is needed to determine whether this impacts clinical outcomes, such as the reduction of diagnosis and treatment errors.
Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Tex; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex. Electronic address: ashley.meyer2@va.gov.
Ashley N D
AN
Meyer
Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Tex; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Tex.
Hardeep
H
Singh
RTI International, Research Triangle Park, NC; SUNY Stony Brook School of Medicine, New York, NY.
Mark L
ML
Graber
D000066491:Clinical Decision-Making; D006801:Humans; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014481:United States
Diagnosis; Diagnostic errors; Patient Safety; Second opinions; Treatment