Electronic health record-based surveillance of diagnostic errors in primary care.
Electronic health record-based surveillance of diagnostic errors in primary care.
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DOI：
10.1136/bmjqs-2011-000304
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发表时间：
2012-02
影响因子：
5.4
通讯作者：
Thomas EJ
中科院分区：
文献类型：
--
作者：
Singh H;Giardina TD;Forjuoh SN;Reis MD;Kosmach S;Khan MM;Thomas EJ
初级保健中的诊断错误是有害的，但很难发现。我们测试了一种基于电子健康记录（EHR）的方法，以检测常规初级保健实践中的诊断错误。我们对通过电子查询“触发”的初级保健访视记录进行了一项回顾性研究，以寻找可能的诊断错误证据：触发1：初级保健索引访视，随后在14天内计划外住院;触发2：初级保健索引访视，随后在14天内≥ 1次计划外访视。对照访视不符合任何标准。2006年10月1日至2007年9月30日期间，电子触发查询应用于两个大型医疗保健系统的EHR存储库。设盲的医生-审查员独立确定在选定的触发和对照访视中是否存在诊断错误。错误定义为在首次访视时获得足够数据时错过做出或寻求正确诊断的机会。分歧由独立的第三方审查员解决。对212，165次访问进行了调查。在记录审查中，我们在674份触发剂1阳性记录中发现了141份诊断错误（PPV= 20.9%，95% CI，17.9%-24.0%），在669份触发剂2阳性记录中发现了36份诊断错误（PPV= 5.4%，95% CI，3.7%-7.1%）。对照PPV为2.1%（95% CI，0.1%-3.3%），显著低于两种触发剂（P ≤ .002）。评定者间可靠性适中，但高于之前的可比研究（κ = 0.37 [95% CI=0.31-0.44]）。虽然医生对诊断错误的一致性仍然很低，但EHR促进的监测方法可能有助于深入了解这些错误的起源。
Diagnostic errors in primary care are harmful but difficult to detect. We tested an electronic health record (EHR)-based method to detect diagnostic errors in routine primary care practice. We conducted a retrospective study of primary care visit records “triggered” through electronic queries for possible evidence of diagnostic errors: Trigger 1: A primary care index visit followed by unplanned hospitalization within 14 days; and Trigger 2: A primary care index visit followed by ≥ 1 unscheduled visit(s) within 14 days. Control visits met neither criterion. Electronic trigger queries were applied to EHR repositories at two large healthcare systems between October 1, 2006 and September 30, 2007. Blinded physician-reviewers independently determined presence or absence of diagnostic errors in selected triggered and control visits. An error was defined as a missed opportunity to make or pursue the correct diagnosis when adequate data was available at the index visit. Disagreements were resolved by an independent third reviewer. Queries were applied to 212,165 visits. On record review, we found diagnostic errors in 141 of 674 Trigger 1-positive records (PPV=20.9%, 95% CI, 17.9%-24.0%) and 36 of 669 Trigger 2-positive records (PPV=5.4%, 95% CI, 3.7%-7.1%). The control PPV of 2.1% (95% CI, 0.1%-3.3%) was significantly lower than that of both triggers (P ≤ .002). Inter-rater reliability was modest, though higher than in comparable previous studies (κ = 0.37 [95% CI=0.31-0.44]). While physician agreement on diagnostic error remains low, an EHR-facilitated surveillance methodology could be useful for gaining insight into the origin of these errors.
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影响因子：
11.4
作者：
Bhasale, AL;Miller, GC;Britt, HC
通讯作者：
Britt, HC
影响因子：
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作者：
Schiff, Gordon D.;Hasan, Omar;McNutt, Robert A.
通讯作者：
McNutt, Robert A.
影响因子：
120.7
作者：
CLASSEN, DC;PESTOTNIK, SL;BURKE, JP
通讯作者：
BURKE, JP
影响因子：
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作者：
Phillips, RL;Bartholomew, LA;Green, LA
通讯作者：
Green, LA
影响因子：
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作者：
Fischhoff, B
通讯作者：
Fischhoff, B