New AHRQ Report Describes Framework for Measuring Diagnostic Error

A new AHRQ-supported report published in BMJ Quality & Safetydescribes a conceptual model called the Safer Dx Framework that is designed to systematically measure and monitor diagnostic errors. The Safer Dx Framework examines diagnostic safety from three perspectives: variables within the environment in which diagnoses take place (such as the internal physical/organizational medical setting), the process for making diagnoses (such as interpersonal aspects between clinician/patient) and patient outcomes (patient health status or behavior). The authors said the Safer Dx Framework is intended to facilitate feedback and learning that can improve diagnostic safety and help make it a safety priority within the medical organization. They said that diagnostic error is a relatively understudied and unmeasured area of patient safety and that most health care organizations lack the tools and strategies to address it or make it a patient safety priority. The report, “Advancing the Science of Measurement of Diagnostic Errors in Health Care: The Safer Dx Framework,” was published online January 14.

BMJ Qual Saf

doi:10.1136/bmjqs-2014-003675

Viewpoint

Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework

+Author Affiliations

¹Houston 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, USA
²University of Texas School of Biomedical Informatics and the UT-Memorial Hermann Center for Healthcare Quality & Safety, Houston, Texas, USA

Correspondence toDr Hardeep Singh, VA Medical Center (152), 2002 Holcombe Blvd, Houston, TX 77030, USA;hardeeps@bcm.edu

Received 11 October 2014
Revised 5 December 2014
Accepted 21 December 2014
Published Online First 14 January 2015

Abstract

Diagnostic errors are major contributors to harmful patient outcomes, yet they remain a relatively understudied and unmeasured area of patient safety. Although they are estimated to affect about 12 million Americans each year in ambulatory care settings alone, both the conceptual and pragmatic scientific foundation for their measurement is under-developed. Health care organizations do not have the tools and strategies to measure diagnostic safety and most have not integrated diagnostic error into their existing patient safety programs. Further progress toward reducing diagnostic errors will hinge on our ability to overcome measurement-related challenges. In order to lay a robust groundwork for measurement and monitoring techniques to ensure diagnostic safety, we recently developed a multifaceted framework to advance the science of measuring diagnostic errors (The Safer Dx framework). In this paper, we describe how the framework serves as a conceptual foundation for system-wide safety measurement, monitoring and improvement of diagnostic error. The framework accounts for the complex adaptive sociotechnical system in which diagnosis takes place (the structure), the distributed process dimensions in which diagnoses evolve beyond the doctor's visit (the process) and the outcomes of a correct and timely “safe diagnosis” as well as patient and health care outcomes (the outcomes). We posit that the Safer Dx framework can be used by a variety of stakeholders including researchers, clinicians, health care organizations and policymakers, to stimulate both retrospective and more proactive measurement of diagnostic errors. The feedback and learning that would result will help develop subsequent interventions that lead to safer diagnosis, improved value of health care delivery and improved patient outcomes.