Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study.
Delayed diagnosis in primary care is a common, harmful and costly patient safety incident. Its measurement and monitoring are underdeveloped and underutilised. We created and implemented a novel approach to identify problems leading to and solutions for delayed diagnosis in primary care.



We developed a novel priority-setting method for patient safety problems and solutions called PRIORITIZE. We invited more than 500 NW London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to delayed diagnosis in primary care. 113 clinicians submitted their suggestions which were thematically grouped and synthesized into a composite list of 33 distinct problems and 27 solutions. A random group of 75 clinicians from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians' scores was presented using the Average Expert Agreement.



The top ranked problems were poor communication between secondary and primary care and the inverse care law, i.e. a mismatch between patients' medical needs and healthcare supply. The highest ranked solutions included: a more rigorous system of communicating abnormal results of investigations to patients, direct hotlines to specialists for GPs to discuss patient problems and better training of primary care clinicians in relevant areas. A priority highlighted throughout the findings is a need to improve communication between clinicians as well as with patients. The highest ranked suggestions had the highest consensus between experts.



The novel method we have developed is highly feasible, informative and scalable, and merits wider exploration with a view of becoming part of a routine pro-active and preventative system for patient safety assessment. Clinicians proposed a range of concrete suggestions with an emphasis on improving communication among clinicians and with patients and better GP training. In their view, delayed diagnosis can be largely prevented with interventions requiring relatively minor investment. Rankings of identified problems and solutions can serve as an aid to policy makers and commissioners of care in prioritization of scarce healthcare resources.
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK. l.tudor.car@imperial.ac.uk.
Lorainne
L
Tudor Car
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
Nikolaos
N
Papachristou
Imperial College Health Partners, London, UK.
Adrian
A
Bull
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
Azeem
A
Majeed
gHealth Research Group, UCD Conway Institute, University College Dublin School of Medicine, Dublin, Ireland.
Joseph
J
Gallagher
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
Mona
M
El-Khatib
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
Paul
P
Aylin
Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK.
Igor
I
Rudan
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, USA.|Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, USA.
Rifat
R
Atun
Health Services and Outcomes Research Programme, LKCMedicine, Nanyang Technological University, Singapore, Singapore.
Josip
J
Car
Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, UK.
Charles
C
Vincent
D003144:Communication Barriers; D063045:Crowdsourcing; D057210:Delayed Diagnosis / Q000517:prevention & control*; D058006:General Practice / Q000193:education; D006801:Humans; D033183:Interdisciplinary Communication; D010342:Patient Acceptance of Health Care; D061214:Patient Safety; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods* / Q000592:standards*; D011340:Problem Solving; D058996:Quality Improvement
Clinicians; Crowd-sourcing; Delayed diagnosis; Patient safety; Primary care; Prioritization