title: Measures to Improve Diagnostic Safety in Clinical Practice.
abstract: Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health-care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm.
authors: From the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors: Hardeep
authors: H
authors: Singh
authors: RTI International, Raleigh-Durham, North Carolina.|SUNY Stony Brook School of Medicine, Stony Brook.|Society to Improve Diagnosis in Medicine, New York, New York.
authors: Mark L
authors: ML
authors: Graber
authors: VA Center for Clinical Management Research.|Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, Michigan.
authors: Timothy P
authors: TP
authors: Hofer
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D006801:Humans; D058996:Quality Improvement / Q000592:standards*; D017751:Safety Management / Q000592:standards*