TY - JOUR
T1 - Missed diagnostic opportunities and English general practice
T2 - A study to determine their incidence, confounding and contributing factors and potential impact on patients through retrospective review of electronic medical records
AU - Cheraghi-Sohi, S
AU - Singh, H
AU - Reeves, D
AU - Stocks, J
AU - Rebecca, M
AU - Esmail, A
AU - CAMPBELL, Stephen
AU - de Wet, C
N1 - Funding Information:
The authors acknowledge the contribution of Dr Rahul Alam and Angela Swallow. The research was funded by the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Funding Information:
Dr. Singh is partially supported by the Houston VA Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413). All other authors confirm that they have no competing interests.
Publisher Copyright:
© 2015 Cheraghi-Sohi et al.
PY - 2015
Y1 - 2015
N2 - Background: Patient safety research has focused largely on hospital settings despite the fact that in many countries, the majority of patient contacts are in primary care. The knowledge base about patient safety in primary care is developing but sparse and diagnostic error is a relatively understudied and an unmeasured area of patient safety. Diagnostic error rates vary according to how 'error' is defined but one suggested hallmark is clear evidence of 'missed opportunity' (MDOs) makes a correct or timely diagnosis to prevent them. While there is no agreed definition or method of measuring MDOs, retrospective manual chart or patient record reviews are a 'gold standard'. This study protocol aims to (1) determine the incidence of MDOs in English general practice, (2) identify the confounding and contributing factors that lead to MDOs and (3) determine the (potential) impact of the detected MDOs on patients. Methods/Design: We plan to conduct a two-phase retrospective review of electronic health records in the Greater Manchester (GM) area of the UK. In the first phase, clinician reviewers will calibrate their performance in identifying and assessing MDOs against a gold standard 'primary reviewer' through the use of 'double' reviews of records. The findings will enable a preliminary estimate of the incidence of MDOs in general practice, which will be used to calculate the number of records to be reviewed in the second phase in order to estimate the true incidence of MDO in general practice. A sample of 15 general practices is required for phase 1 and up to 35 practices for phase 2. In each practice, the sample will consist of 100 patients aged =18 years on 1 April 2013 who have attended a face-to-face 'index consultation' between 1 April 2013 and 31 March 2015. The index consultation will be selected randomly from each unique patient record, occurring between 1 July 2013 and 30 June 2014. Discussion: There are no reliable estimates of safety problems related to diagnosis in English general practice. This study will lay the foundation for safety improvements in this area by providing a more reliable estimate of MDOs, their impact and their contributory factors.
AB - Background: Patient safety research has focused largely on hospital settings despite the fact that in many countries, the majority of patient contacts are in primary care. The knowledge base about patient safety in primary care is developing but sparse and diagnostic error is a relatively understudied and an unmeasured area of patient safety. Diagnostic error rates vary according to how 'error' is defined but one suggested hallmark is clear evidence of 'missed opportunity' (MDOs) makes a correct or timely diagnosis to prevent them. While there is no agreed definition or method of measuring MDOs, retrospective manual chart or patient record reviews are a 'gold standard'. This study protocol aims to (1) determine the incidence of MDOs in English general practice, (2) identify the confounding and contributing factors that lead to MDOs and (3) determine the (potential) impact of the detected MDOs on patients. Methods/Design: We plan to conduct a two-phase retrospective review of electronic health records in the Greater Manchester (GM) area of the UK. In the first phase, clinician reviewers will calibrate their performance in identifying and assessing MDOs against a gold standard 'primary reviewer' through the use of 'double' reviews of records. The findings will enable a preliminary estimate of the incidence of MDOs in general practice, which will be used to calculate the number of records to be reviewed in the second phase in order to estimate the true incidence of MDO in general practice. A sample of 15 general practices is required for phase 1 and up to 35 practices for phase 2. In each practice, the sample will consist of 100 patients aged =18 years on 1 April 2013 who have attended a face-to-face 'index consultation' between 1 April 2013 and 31 March 2015. The index consultation will be selected randomly from each unique patient record, occurring between 1 July 2013 and 30 June 2014. Discussion: There are no reliable estimates of safety problems related to diagnosis in English general practice. This study will lay the foundation for safety improvements in this area by providing a more reliable estimate of MDOs, their impact and their contributory factors.
KW - Diagnoses
KW - Diagnostic error
KW - General practice
KW - Missed diagnostic opportunities
KW - Patient safety
KW - Primary care
UR - http://www.scopus.com/inward/record.url?scp=84938200934&partnerID=8YFLogxK
UR - http://www.mendeley.com/research/missed-diagnostic-opportunities-english-general-practice-study-determine-incidence-confounding-contr
U2 - 10.1186/s13012-015-0296-z
DO - 10.1186/s13012-015-0296-z
M3 - Article
C2 - 26220545
SN - 1748-5908
VL - 10
SP - 1
EP - 9
JO - Implementation Science
JF - Implementation Science
M1 - 105
ER -