The challenges in defining and measuring diagnostic error

Abstract

Diagnostic errors have emerged as a serious patient safety problem but they are hard to detect and complex to define. At the research summit of the 2013 Diagnostic Error in Medicine 6th International Conference, we convened a multidisciplinary expert panel to discuss challenges in defining and measuring diagnostic errors in real-world settings. In this paper, we synthesize these discussions and outline key research challenges in operationalizing the definition and measurement of diagnostic error. Some of these challenges include 1) difficulties in determining error when the disease or diagnosis is evolving over time and in different care settings, 2) accounting for a balance between underdiagnosis and overaggressive diagnostic pursuits, and 3) determining disease diagnosis likelihood and severity in hindsight. We also build on these discussions to describe how some of these challenges can be addressed while conducting research on measuring diagnostic error.

Challenges and opportunities from the Agency for Healthcare Research and Quality (AHRQ) research summit on improving diagnosis: a proceedings review

“…The definition is appropriately patient-centered, and experts are still debating how to operationalize the definition as they derive useful measures of both diagnostic processes and outcomes. Efforts to achieve a more unifying terminology and greater clarity are ongoing [7,8]. Nearly everyone recognizes the complexity involved.…”

The IOM report on improving diagnosis: new concepts

“…The three previous definitions separate out these concepts, with my own definition focusing on the label, and the newer definitions of Hardeep Singh and Gordon Schiff focusing on the process. These definitions, if anything, are more complementary than conflicting, because they each have specific uses in health services research studies [3,4]. My own definition (the diagnosis label is wrong, missed, or delayed) generally identifies unambiguous cases of diagnostic error, but can only be applied in retrospect, requires definitive information of some sort, and is subject to hindsight bias [5].…”

Understanding diagnostic error: looking beyond diagnostic accuracy

“…However as methods such as these are retrospective and subject to hindsight bias [3], they are unlikely to reflect how a diagnosis is assigned in a real life clinical setting. The shift by Singh and colleagues to examining and measuring 'missed opportunities' rather than 'diagnostic errors' [4,5,6] attempts to address the difficulties in attaining agreement on what constitutes a diagnostic error.…”

“…Confusing clinical pictures and deviations from expected trajectories may contribute to misdiagnosis or Unauthenticated Download Date | 5/11/18 1:47 PM diagnostic delay [3]. For doctors, it is clear that diagnosis is not a singular event occurring at a given point in time, but an on-going messy process that may take minutes, days, weeks or sometimes years.…”