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National Academies Press


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Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative.

Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errors—has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

Product Details

ISBN-13: 9780309377690
Publisher: National Academies Press
Publication date: 01/29/2016
Pages: 472
Sales rank: 870,983
Product dimensions: 6.00(w) x 8.90(h) x 1.20(d)

Table of Contents

Acronyms and Abbreviations xxv

Summary 1

1 Introduction 19

Context of the Study 22

Origin of Task and Committee Charge 23

Methods of the Study 23

Conceptual Model 24

Examples of Diagnosis and Diagnostic Errors 24

Organization of the Report 26

References 28

2 The Diagnostic Process 31

Overview of the Diagnostic Process 32

Important Considerations in the Diagnostic Process 48

Clinical Reasoning and Diagnosis 53

The Diagnostic Evidence Base and Clinical Practice 66

References 69

3 Overview of Diagnostic Error in Health Care 81

Definition of Diagnostic Error 81

Overutilization in the Diagnostic Process and Overdiagnosis 90

Measurement and Assessment of Diagnostic Error 94

References 135

4 Diagnostic Team Members and Tasks: Improving Patient Engagement and Health Care Professional Education and Training in Diagnosis 145

The Diagnostic Process as a Team Endeavor 145

Patient Engagement in Diagnosis 160

Health Care Professional Education and Training 177

Recommendations 196

References 197

5 Technology and Tools in the Diagnostic Process 217

Design of Health IT for the Diagnostic Process 219

Interoperability of Health IT 237

Safety of Health IT in Diagnosis 243

Other Diagnostic Technologies 246

Recommendation 251

References 252

6 Organizational Characteristics the Physical Environment and the Diagnostic Process: Improving Learning Culture and the Work System 263

Organizational Learning to Improve Diagnosis 264

Organizational Characteristics for Learning and Improved Diagnosis 279

A Supportive Work System to Facilitate Diagnosis 286

Recommendations 292

References 293

7 The External Environment Influencing Diagnosis: Reporting Medical Liability, and Payment 307

Reporting and Learning from Diagnostic Errors 308

Medical Liability 314

Risk Management 324

Payment and Care Delivery 326

Recommendations 334

References 335

8 A Research Agenda for the Diagnostic Process and Diagnostic Error 343

A Federal Research Agenda 344

Public-Private Collaboration on Research 346

Recommendation 351

References 352

9 The Path to Improve Diagnosis and Reduce Diagnostic Error 355

Overarching Conclusions 355

Recommendations 357

References 391


A Glossary 403

B Committee Member and Staff Biographies 411

C Previous Diagnostic Error Frameworks 429

D Examples of Diagnostic Error 437

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