The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations.
The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations.
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DOI：
10.1136/bmjqs-2013-002627
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发表时间：
2014-09
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;Meyer AN;Thomas EJ
门诊诊断错误的频率是具有挑战性的，以确定由于不同的错误定义和需要审查数据跨多个提供者和护理设置随着时间的推移。我们通过综合之前三项临床人群研究的数据，估计了美国成年人群中诊断错误的频率，这些研究使用了概念上相似的诊断错误定义。数据来源包括之前的两项研究，这些研究使用电子触发器或算法来检测初始初级保健访视后回访的异常模式或缺乏与结直肠癌相关的异常临床结果的随访，这两种情况都表明诊断错误。第三项研究检查了连续的肺癌病例。在所有三项研究中，诊断错误都是通过病历审查确认的，并定义为错过了根据现有证据做出及时或正确诊断的机会。我们将从我们的研究中获得的诊断错误频率外推至美国成年人群，使用初级保健研究估计急性疾病（和现有疾病的恶化）的诊断错误率，并使用两项癌症研究保守估计结直肠癌和肺癌（作为其他严重慢性疾病的替代品）的漏诊率。综合这三项研究的估计，门诊诊断错误率为5.08%，即每年约有1200万美国成年人。根据以前的工作，我们估计这些错误中约有一半可能是有害的。我们基于人口的估计表明，诊断错误影响至少1/20的美国成年人。这一基本证据应鼓励政策制定者、医疗机构和研究人员开始衡量和减少诊断错误。
The frequency of outpatient diagnostic errors is challenging to determine due to varying error definitions and the need to review data across multiple providers and care settings over time. We estimated the frequency of diagnostic errors in the US adult population by synthesising data from three previous studies of clinic-based populations that used conceptually similar definitions of diagnostic error. Data sources included two previous studies that used electronic triggers, or algorithms, to detect unusual patterns of return visits after an initial primary care visit or lack of follow-up of abnormal clinical findings related to colorectal cancer, both suggestive of diagnostic errors. A third study examined consecutive cases of lung cancer. In all three studies, diagnostic errors were confirmed through chart review and defined as missed opportunities to make a timely or correct diagnosis based on available evidence. We extrapolated the frequency of diagnostic error obtained from our studies to the US adult population, using the primary care study to estimate rates of diagnostic error for acute conditions (and exacerbations of existing conditions) and the two cancer studies to conservatively estimate rates of missed diagnosis of colorectal and lung cancer (as proxies for other serious chronic conditions). Combining estimates from the three studies yielded a rate of outpatient diagnostic errors of 5.08%, or approximately 12 million US adults every year. Based upon previous work, we estimate that about half of these errors could potentially be harmful. Our population-based estimate suggests that diagnostic errors affect at least 1 in 20 US adults. This foundational evidence should encourage policymakers, healthcare organisations and researchers to start measuring and reducing diagnostic errors.
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