Enhancing the Quality and Delivery of Healthcare: A Decade Review of Autopsy Data

Abstract

Quality management is of the utmost importance for providing the best patient care in our healthcare system. Patients rightfully expect the care that they receive to be of sound quality. The medical autopsy has been used as the gold standard of diagnostic medicine and continues to provide insights into strategies for healthcare quality improvement. The discordance and concordance rates between autopsy and clinical diagnoses have been used to identify areas of improvement and provide education opportunities to healthcare professionals. Discordance between autopsy and clinical diagnoses has revealed several areas in which clinicians need to improve their diagnostic skills and implement systemic changes to detect and mitigate diagnostic errors. Unfortunately, the rate of hospital autopsies has declined over the past several decades. The purpose of this study was to expand our previous work and combine the analyses of discordance and concordance between autopsy and clinical diagnoses across a 10-year period from 2002 to 2011 and to assess the role of the medical autopsy as a quality improvement tool in modern healthcare systems. Within our study, the autopsy rate of all in-patient deaths was approximately 6%. Our study indicates that the concordance rate between clinical and autopsy diagnoses was 77.5%, the discordance rate was 19.4%, and 3.1% were inconclusive. The discordance rate varied from as low as 9.7% in 2007 to as high as 27.1% in 2002. These findings suggest that overall, approximately 1 in 5 autopsies revealed discordance between autopsy and clinical diagnoses. This is a significant number of cases for which there exists both quality improvement and educational opportunities, thus, supporting the continued use of autopsy. We suggest these data should be used to encourage residents and physicians to continue using autopsy as an important quality tool to extend our understanding of disease processes. Hospital autopsies are closely associated with quality improvement and better patient care.