Collaborative Research: HNDS-R Networks and Health Disparities in Delays in Diagnosis of Medical Conditions with Ambiguous Symptoms

错过、延迟或不准确的医疗诊断（即诊断错误）是美国每年高达80,000例医院死亡的原因。有些疾病不容易诊断，因为症状含糊不清或容易与其他疾病混淆，从而导致诊断错误。对于医生可能没有太多经验的罕见疾病，情况尤其如此。本项目考察边缘化地位（例如，种族和族裔上属于少数群体的人和妇女）和医患网络关系的结构是否与症状不明确的医疗条件的诊断延误有关。该项目的研究结果可以导致更好的医疗保健干预措施，从而减少与诊断错误有关的健康差距。该项目确定了社会和结构的预测延迟诊断的医疗条件与模糊的症状。根据社会心理学的理论，本研究假设，由于诊断过程可能受到种族、性别和其他刻板印象的影响，边缘化人群更有可能在诊断症状不明确的疾病时经历更长的延误。根据网络科学的理论，这项研究假设，鼓励接触非冗余信息（新的可能的诊断或测试考虑）的医患网络结构，以及医生接受错误和纠正误诊的意愿增加，与更快地诊断出具有模糊症状的医疗条件有关。该项目将纵向医疗补助分析提取（MAX）医疗索赔数据与美国医学协会（AMA）医师主档案数据相结合，以定量地检验这些假设。医患网络是通过患者和医生之间基于临床接触的直接联系和医生之间通过他们共享的患者的间接联系来构建的。这个项目对于理解社会网络如何影响医患关系和诊断过程，以及减少美国医疗保健系统中诊断错误的数量非常重要。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

Missed, delayed, or inaccurate medical diagnoses (i.e., diagnostic errors) are responsible for up to 80,000 hospital deaths in the United States annually. Some medical conditions are not easy to diagnose because symptoms are ambiguous or easy to confuse with other conditions, which contributes to diagnostic errors. This is especially the case for rare diseases with which physicians may not have much experience. This project examines whether marginalized status (e.g., racially and ethnically minoritized people and women) and the structure of patient-physician network ties are associated with delays in diagnosis of medical conditions with ambiguous symptoms. The findings from this project can lead to better healthcare interventions that could reduce health disparities related to diagnostic errors.This project determines the social and structural predictors of delays in diagnosis of medical conditions with ambiguous symptoms. Drawing on theories from social psychology, this study hypothesizes that marginalized people are more likely to experience longer delays in diagnosis of diseases with ambiguous symptoms because the diagnostic process can be affected by racial, gender, and other stereotypes. Drawing on theories from network science, this study hypothesizes that patient-physician network structures that encourage exposure to non-redundant information (new possible diagnoses or tests to consider), together with physicians’ increased willingness to accept mistakes and correct misdiagnoses are associated with faster times to diagnoses of medical conditions with ambiguous symptoms. The project combines Longitudinal Medicaid Analytic eXtract (MAX) medical claims data with the American Medical Association (AMA) Physician Masterfile data to quantitatively test these hypotheses. Patient-physician networks are constructed through direct links between patients and physicians based on clinical encounters and indirect links between physicians through the patients they share. This project is important for understanding how social networks influence the patient-physician relationship and diagnostic processes, and for reducing the number of diagnostic errors in the U.S. healthcare system.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.