Many Americans have experienced the consequences and health-related anxieties that follow a diagnostic error—a diagnosis that is either delayed, poorly communicated, or simply wrong.
Understandably, diagnosis can be difficult given the complexities and ambiguities of medical care and the variation of symptoms from one patient to another. Some signs suggest that progress is being made. However, reliable estimates show that diagnostic errors nevertheless remain very common.
One in 20 adults each year experiences a diagnostic error in outpatient settings. About 250,000 diagnostic errors occur each year in American hospitals. Regardless of the setting, diagnostic errors can derail proper care and can lead to serious injury or death. These issues have been amplified by COVID-19 and its impact on caregivers and the health care delivery system.
AHRQ’s newest clinical tool—Dx Measure—is an essential addition to the inventory of resources that can help prevent diagnostic errors. Measure Dx is available to any healthcare organization interested in promoting diagnostic excellence. It is an evidence-based tool that helps identify diagnostic safety events and gain insights for improvement. Measure Dx provides practical guidance and modular, scalable strategies to detect and learn from diagnostic security events. These strategies are presented in a four-part guide that provides:
- Strategies to engage people in your organization so that the right resources are dedicated to implementing measurement and learning activities.
- A self-assessment checklist to assess readiness for implementation, as well as guidance for choosing a measurement strategy that fits within organizational resources.
- Measurement strategies for different types of data sources.
- Recommendations for systematically reviewing and analyzing case data and translating findings into valuable knowledge for improvement.
Measure Dx illustrates AHRQ’s ongoing commitment to diagnostic excellence. These efforts have gained momentum in recent years in critical areas.
Major federal efforts: In response to a 2017 Senate report, AHRQ created the Federal Interagency Task Force on Improving Diagnostic Safety and Quality in Health Care. With representation from 12 agencies, the task force strives to improve scientific research as described in Improving Diagnosis in Healthcarea landmark 2015 report from the National Academies of Sciences, Engineering, and Medicine.
Increasing the scope of the search: In 2019, Congress authorized $2 million in grants to AHRQ to launch a research agenda to understand and solve the problem of diagnostic errors. Building on this work, which will be completed at the end of September, AHRQ announced earlier this year that it will provide up to an additional $8 million to support up to 8 Diagnostic Centers of Excellence. These centers will develop expertise in at least one of four areas: error detection and prevention, consistency for safe practice, improving diagnostic accuracy through consensus, and improving “truth” or diagnostic reference standards. AHRQ funds additional diagnostic safety research through Notice of Funding Opportunities announcements, including Patient Safety Learning Labs and general Program Announcements.
Clinical support teams: AHRQ has developed numerous practical tools to advance accurate and timely diagnosis. They include the Patient Engagement Toolkit to Improve Diagnostic Safety; Briefs on diagnostic safety issues that review current topics and support improvement efforts; a TeamSTEPPS® training program designed specifically for diagnostic improvements; and a recent addition to AHRQ’s Patient Safety Culture Surveys (SOPS ® ) for organizations to assess support for accurate diagnoses.
Promotion of standardized data collection: In May, AHRQ released Common Event Reporting Formats – Diagnostic Safety Version 1.0. This resource is intended to help healthcare providers collect diagnostic safety event data in a standardized manner across healthcare settings and specialties. Data analysis can help organizations learn how to improve diagnostic certainty and better support clinicians in the diagnostic process. Widespread use will enable the collection, aggregation and analysis of safety-related diagnostic information nationwide, which will accelerate learning. Measure Dx recommends using these standard case analysis formats.
All of AHRQ’s efforts in diagnostic safety — its leading role among federal agencies, its research investments, its tools and resources — aim for the same goal: to provide the best possible patient care, especially as we continue to face with the COVID-19 pandemic and other public health emergencies. We believe that every American deserves a health care system that provides timely and accurate diagnoses and care. We hope you find the new one Measure Dx tool and many other AHRQ resources essential additions to your diagnostic safety resources.
Dr. Valdez is the Director of AHRQ.
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