We aimed to test the accuracy of an instrument to help detect presence or absence of diagnostic error through record reviews.
Accuracy of the Safer Dx Instrument to Identify Diagnostic Errors in Primary Care
Published in: Journal of General Internal Medicine, 2016
Posted on RAND.org on March 02, 2016
- How well does Safer Dx, a research instrument, spot medical diagnosis errors?
IMPORTANCE: Diagnostic errors are common and harmful, but difficult to define and measure. Measurement of diagnostic errors often depends on retrospective medical record reviews, frequently resulting in reviewer disagreement. OBJECTIVES: We aimed to test the accuracy of an instrument to help detect presence or absence of diagnostic error through record reviews. DESIGN: We gathered questions from several previously used instruments for diagnostic error measurement, then developed and refined our instrument. We tested the accuracy of the instrument against a sample of patient records (n = 389), with and without previously identified diagnostic errors (n = 129 and n = 260, respectively). RESULTS: The final version of our instrument (titled Safer Dx Instrument) consisted of 11 questions assessing diagnostic processes in the patient–provider encounter and a main outcome question to determine diagnostic error. In comparison with the previous sample, the instrument yielded an overall accuracy of 84 %, sensitivity of 71 %, specificity of 90 %, negative predictive value of 86 %, and positive predictive value of 78 %. All 11 items correlated significantly with the instrument's error outcome question (all p values ≤ 0.01). Using factor analysis, the 11 questions clustered into two domains with high internal consistency (initial diagnostic assessment, and performance and interpretation of diagnostic tests) and a patient factor domain with low internal consistency (Cronbach's alpha coefficients 0.93, 0.92, and 0.38, respectively). CONCLUSIONS: The Safer Dx Instrument helps quantify the likelihood of diagnostic error in primary care visits, achieving a high degree of accuracy for measuring their presence or absence. This instrument could be useful to identify high-risk cases for further study and quality improvement.
- Safer Dx Instrument assesses 11 aspects of a primary care encounter for breakdown of the diagnostic process.
- Instrument was tested against 389 patient records containing clinically identified errors.
- The Instrument detected diagnostic errors 84% of the time.
- Safer Dx could help standardize detection of diagnostic error in primary care.