National Academies Press: OpenBook

Improving Diagnosis in Health Care (2015)

Chapter: Front Matter

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

IMPROVING
DIAGNOSIS IN
HEALTH CARE

Committee on Diagnostic Error in Health Care

Erin P. Balogh, Bryan T. Miller, and John R. Ball, Editors

Board on Health Care Services

Institute of Medicine

images

THE NATIONAL ACADEMIES PRESS

Washington, DC

www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

THE NATIONAL ACADEMIES PRESS    500 Fifth Street, NW    Washington, DC 20001

This activity was supported by Contracts HHSH25034020T and 200-2011-38807, TO#20 between the National Academy of Sciences and the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention, respectively. This study was also supported by the American College of Radiology, American Society for Clinical Pathology, Cautious Patient Foundation, College of American Pathologists, The Doctors Company Foundation, Janet and Barry Lang, Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation, and Robert Wood Johnson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

Library of Congress Cataloging-in-Publication Data

Names: Balogh, Erin, editor. | Miller, Bryan T., editor. | Ball, John, 1944- , editor. | Institute of Medicine (U.S.). Committee on Diagnostic Error in Health Care, issuing body.

Title: Improving diagnosis in health care / Committee on Diagnostic Error in Health Care ; Erin P. Balogh, Bryan T. Miller, and John R. Ball, editors ; Board on Health Care Services, Institute of Medicine, The National Academies of Sciences, Engineering, and Medicine.

Description: Washington, DC : The National Academies Press, [2015] | Includes bibliographical references.

Identifiers: LCCN 2015041708|ISBN 9780309377690 (pbk.) | ISBN 9780309377706 (pdf)

DOI: 10.17226/21794

Subjects: | MESH: Diagnostic Errors—prevention & control—United States. | Diagnostic Techniques and Procedures—United States.

Classification: LCC RC71.5 | NLM WB 141 | DDC 616.07/50289—dc23 LC record available at http://lccn.loc.gov/2015041708

Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2015 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Cover credit: LeAnn Locher & Associates.

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2015. Improving diagnosis in health care. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

images

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

COMMITTEE ON DIAGNOSTIC ERROR IN HEALTH CARE

JOHN R. BALL (Chair), Executive Vice President Emeritus, American College of Physicians and American Society for Clinical Pathology

ELISABETH BELMONT, Corporate Counsel, MaineHealth

ROBERT A. BERENSON, Institute Fellow, Urban Institute

PASCALE CARAYON, Procter & Gamble Bascom Professor in Total Quality and Director, Center for Quality and Productivity Improvement, University of Wisconsin–Madison

CHRISTINE K. CASSEL, President and Chief Executive Officer, National Quality Forum

CAROLYN M. CLANCY, Chief Medical Officer, Veterans Health Administration, Department of Veterans Affairs

MICHAEL B. COHEN, Medical Director, Anatomic Pathology and Oncology Division, ARUP Laboratories; Professor and Vice Chair for Faculty Development, Ombudsperson, Health Sciences Center, University of Utah School of Medicine

PATRICK CROSKERRY, Professor of Emergency Medicine and Director, Critical Thinking Program, Dalhousie University Medical School, Dalhousie University

THOMAS H. GALLAGHER, Professor and Associate Chair, Department of Medicine; Director, Hospital Medicine and Center for Scholarship in Patient Care Quality and Safety, University of Washington

CHRISTINE A. GOESCHEL, Assistant Vice President, Quality, MedStar Health

MARK L. GRABER, Senior Fellow, RTI International

HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center

ANUPAM B. JENA, Associate Professor of Health Care Policy and Medicine, Harvard Medical School

ASHISH K. JHA, K.T. Li Professor of International Health and Director, Harvard Global Health Institute, Harvard T.H. Chan School of Public Health

MICHAEL LAPOSATA, Professor and Chair, Department of Pathology, University of Texas Medical Branch at Galveston

KATHRYN McDONALD, Executive Director and Senior Scholar, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University

ELIZABETH A. McGLYNN, Director, Center for Effectiveness and Safety Research, Kaiser Permanente

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

MICHELLE ROGERS, Associate Professor, College of Computing and Informatics, Drexel University

URMIMALA SARKAR, Associate Professor of Medicine, University of California, San Francisco

GEORGE E. THIBAULT, President, Josiah Macy Jr. Foundation

JOHN B. WONG, Chief, Division of Clinical Decision Making, Tufts Medical Center

Study Staff

ERIN BALOGH, Study Director

BRYAN MILLER, Research Associate (from August 2014)

SARAH NAYLOR, Research Associate (until August 2014)

KATHRYN GARNHAM ELLETT, Research Associate (from April 2015 to July 2015)

CELYNNE BALATBAT, Research Assistant (until June 2015)

PATRICK ROSS, Research Assistant (from April 2015)

LAURA ROSEMA, Christine Mirzayan Science and Technology Policy Graduate Fellow (from January to April 2014)

BEATRICE KALISCH, Nurse Scholar in Residence (until August 2014)

PATRICK BURKE, Financial Associate

ROGER HERDMAN, Director, Board on Health Care Services (until June 2014)

SHARYL NASS, Director, Board on Health Care Services (from June 2014); Director, National Cancer Policy Forum

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

SUZANNE BAKKEN, Columbia University

DONALD BERWICK, Institute for Healthcare Improvement

PAUL CHANG, University of Chicago Hospitals

JAMES J. CIMINO, University of Alabama at Birmingham

SARA J. CZAJA, University of Miami Miller School of Medicine

GURPREET DHALIWAL, University of California, San Francisco, and San Francisco Veterans Affairs Medical Center

TEJAL GANDHI, National Patient Safety Foundation

HELEN HASKELL, Mothers Against Medical Error

JOHN M. HICKNER, University of Illinois at Chicago

MICHELLE MELLO, Stanford Law School

JEFFREY MEYERS, University of Michigan

MARGARET E. O’KANE, National Committee for Quality Assurance

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

GORDON SCHIFF, Brigham and Women’s Hospital and Harvard Medical School

SUSAN SHERIDAN, Patient-Centered Outcomes Research Institute

HARDEEP SINGH, Houston Veterans Affairs Health Services Research Center for Innovations, Michael E. DeBakey Veterans Affairs Medical Center, and Baylor College of Medicine

BRIAN R. SMITH, Yale University School of Medicine

LAURA ZWAAN, Erasmus Medical Center

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by BRADFORD H. GRAY, Editor Emeritus, The Milbank Quarterly, Senior Fellow, Urban Institute, and KRISTINE GEBBIE, Flinders University School of Nursing and Midwifery, Adelaide, South Australia. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

Acknowledgments

We thank the following individuals who spoke at the committee’s meetings:

Bibb Allen, American College of Radiology

Leonard Berlin, Skokie Hospital, Rush Medical College, University of Illinois

Barbara Brandt, National Center for Interprofessional Practice and Education, University of Minnesota

David Classen, Pascal Metrics and University of Utah School of Medicine

Gurpreet Dhaliwal, University of California, San Francisco, and San Francisco Veterans Affairs Medical Center

Paul Epner, Society to Improve Diagnosis in Medicine

Tejal Gandhi, National Patient Safety Foundation

Emmy Ganos, Robert Wood Johnson Foundation

David Gross, College of American Pathologists

Kerm Henriksen, Agency for Healthcare Research and Quality

Devery Howerton, Centers for Disease Control and Prevention

Heidi Julavits, Columbia University

Allen Kachalia, Brigham and Women’s Hospital, Harvard Medical School, and Harvard School of Public Health

Michael Kanter, Kaiser Permanente

Jerome Kassirer, Tufts University School of Medicine

Steven Kroft, American Society for Clinical Pathology

Michael Millenson, Cautious Patient Foundation

Elizabeth Montgomery, Cautious Patient Foundation

Jeffrey Myers, University of Michigan

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

David E. Newman-Toker, Johns Hopkins University School of Medicine

Harold Pincus, New York–Presbyterian Hospital, Columbia University, and RAND Corporation

Donald Redelmeier, University of Toronto

Eduardo Salas, University of Central Florida

Nadine Sarter, University of Michigan

Gordon Schiff, Brigham and Women’s Hospital and Harvard Medical School

Hardeep Singh, Houston Veterans Affairs Health Services Research Center for Innovations, Michael E. DeBakey Veterans Affairs Medical Center, and Baylor College of Medicine

Stephen Teret, Johns Hopkins University

Eric Thomas, University of Texas Houston Medical School

Robert Trowbridge, Maine Medical Center and Tufts University School of Medicine

David Troxel, The Doctors Company Foundation

We would also like to thank a number of individuals who submitted written input or provided public comments at the committee meetings that informed the committee’s deliberations. These individuals included:

Melissa Anselmo, OpenNotes

Signall Bell, OpenNotes

Ann Bisantz, University at Buffalo

Dennis Boyle, COPIC

John E. Brush, Jr., Eastern Virginia Medical School and Sentara Healthcare, Norfolk, Virginia

Tom Delbanco, OpenNotes

Gerri Donohue, Physicians’ Reciprocal Insurers

Steven J. Durning, Uniformed Services University of the Health Sciences

Gary Klein, MacroCognition

Alan Lembitz, COPIC

George Lundberg, Medscape

David L. Meyers, American College of Emergency Physicians

Harold Miller, Center for Healthcare Quality and Payment Reform

Geoff Norman, McMaster University

Carolyn Oliver, Cautious Patient Foundation

Frank Papa, University of North Texas Health Science Center

P. Divya Parikh, PIAA

W. Scott Richardson, GRU/UGA Medical Partnership Campus

Meredith Rosenthal, Harvard School of Public Health

Alan Schwartz, University of Illinois, Chicago

Dana Siegal, CRICO

Olle ten Cate, University Medical Center Utrecht

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

Bill Thatcher, Cautious Patient Foundation

Bill Thorwarth, American College of Radiology

David Troxel, The Doctors Company

Jan Walker, OpenNotes

Saul Weiner, University of Illinois, Chicago, Jesse Brown Veterans Affairs Medical Center

David Wennberg, Northern New England Accountable Care Collaborative

Funding for the study was provided by the Agency for Healthcare Research and Quality, the American College of Radiology, the American Society for Clinical Pathology, the Cautious Patient Foundation, the Centers for Disease Control and Prevention, the College of American Pathologists, The Doctors Company Foundation, Janet and Barry Lang, Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation, and the Robert Wood Johnson Foundation. The committee appreciates the support extended by these sponsors for the development of this report.

We would also like to thank the individuals who shared their experiences with diagnosis in the dissemination video: Sue, Jeff, and Carolyn.

Finally, many within the National Academies of Sciences, Engineering, and Medicine were helpful to the study staff. We would like to thank Clyde Behney, Chelsea Frakes, Greta Gorman, Laurie Graig, Julie Ische, Nicole Joy, Ellen Kimmel, Katye Magee, Fariha Mahmud, Abbey Meltzer, Jonathan Phillips, and Jennifer Walsh.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

This page intentionally left blank.

Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

Preface

Fifteen years ago, in its landmark report To Err Is Human: Building a Safer Health System, the Institute of Medicine (IOM) dramatically exposed the issue of patient safety in health care. Stating the obvious—that human beings make errors—but highlighting the theretofore rarely discussed fact that those of us in health care also make errors, the report began a quiet revolution in the way in which health care organizations address the safety and quality of care. This report, Improving Diagnosis in Health Care, is a follow-up to the earlier report and the most recent in the IOM’s Quality Chasm Series. This report has three major themes.

First, Improving Diagnosis in Health Care exposes a critical type of error in health care—diagnostic error—that has received relatively little attention since the release of To Err Is Human. There are several reasons why diagnostic error has been underappreciated, even though the correct diagnosis is a critical aspect of health care. The data on diagnostic error are sparse, few reliable measures exist, and often the error is identified only in retrospect. Yet the best estimates indicate that all of us will likely experience a meaningful diagnostic error in our lifetime. Perhaps the most significant contribution of this report is to highlight the importance of the issue and to direct discussion among patients and health care professionals and organizations on what should be done about this complex challenge.

Second, patients are central to the solution. The report defines diagnostic error from the patient’s viewpoint as “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient.” The report’s first goal

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

centers on the need to establish partnerships with patients and their families to improve diagnosis, and several recommendations aim to facilitate and enhance such partnerships.

Third, diagnosis is a collaborative effort. The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always true; the diagnostic process often involves intra- and interprofessional teamwork. Nor is diagnostic error always due to human error; often, it occurs because of errors in the health care system. The complexity of health and disease and the increasing complexity of health care demands collaboration and teamwork among and between health care professionals, as well as with patients and their families.

In addition to these major themes, the report highlights several key issues that must be addressed if diagnostic errors are to be reduced:

  • Health care professional education and training does not take fully into account advances in the learning sciences. The report emphasizes training in clinical reasoning, teamwork, and communication.
  • Health information technology, while potentially a boon to quality health care, is often a barrier to effective clinical care in its current form. The report makes several recommendations to improve the utility of health information technology in the diagnostic process specifically and the clinical process more generally.
  • There are few data on diagnostic error. The report recommends, in addition to specified research, the development of approaches to monitor the diagnostic process and to identify, learn from, and reduce diagnostic error.
  • The health care work system and culture do not sufficiently support the diagnostic process. Echoing previous IOM work, the report also recommends the development of an organizational culture that values open discussion and feedback on diagnostic performance.
  • In addition, the report highlights the increasingly important role of radiologists and pathologists as integral members of the diagnostic team.

There were also areas where the committee that developed the report wished we could go further but found that there are insufficient data currently to support strong recommendations. One of those areas is the payment system, now evolving from fee-for-service to more value- and population-based. Research on the effects of novel payment systems on diagnosis is sorely needed. Another area is that of medical liability. The report recommends the adoption of communication and resolution programs as a key lever to improve the disclosure of diagnostic errors to

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

patients and to facilitate improved organizational learning from these events. However, other approaches for the resolution of medical injuries, such as safe harbors for the adherence to evidence-based clinical practice guidelines and administrative health courts, hold promise. More needs to be known of their effect on the diagnostic process, and the report recommends demonstration projects to expand the knowledge base in these areas.

A final area of potential controversy is the measurement of diagnostic errors for public reporting and accountability purposes. The committee believed that, given the lack of an agreement on what constitutes a diagnostic error, the paucity of hard data, and the lack of valid measurement approaches, the time was simply not ripe to call for mandatory reporting. Instead, it is appropriate at this time to leverage the intrinsic motivation of health care professionals to improve diagnostic performance and to treat diagnostic error as a key component of quality improvement efforts by health care organizations. Better identification, analysis, and implementation of approaches to improve diagnosis and reduce diagnostic error are needed throughout all settings of care.

As chair of the committee, I thank all of the members of the committee for their individual and group contributions. I am grateful for the time, energy, and diligence, as well as the diversity of experience and expertise, they all brought to the process. When a diverse group of good people with good intent come together for a common purpose, the process is richer and more enjoyable, and the product more likely to be worthwhile. None of the work of the committee would have been possible without the professional IOM staff, led by the study director, Erin Balogh. Both personally and on behalf of the committee, I thank them for a truly collaborative, incredibly responsive, and productive process.

John R. Ball
Chair
Committee on Diagnostic Error in Health Care

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

This page intentionally left blank.

Page xxii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

4-5 Smart Partners About Your Health

4-6 Attributes of Health Literate Health Care Organizations

4-7 The Learning Sciences

4-8 Situation-Background-Assessment-Recommendation Tool to Improve Communication Among Health Care Professionals

4-9 Examples of Accreditation Organizations for Health Care Professional Education and Training Programs

4-10 Six Core Competencies Developed by the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education

5-1 Recommendations from Health IT and Patient Safety: Building a Safer Health System

5-2 American Medical Association’s Improving Care: Priorities to Improve Electronic Health Record (EHR) Usability

5-3 Categories Describing Different Steps in Diagnosis Targeted by Diagnostic Health Information Technology Tools

5-4 A Case of Diagnostic Error: Delayed Diagnosis of Ebola Virus Infection

5-5 Recommendations from an American Medical Informatics Association Special Task Force on Health Information Technology Contracts

6-1 Characteristics of a Continuously Learning Health Care Organization

6-2 Characteristics of Effective Feedback Interventions

6-3 Important Cultural Values for Continuously Learning Health Care Systems

6-4 A CEO Checklist for High-Value Health Care

7-1 Description of Alternative Approaches to the Medical Liability System

7-2 Payment and Care Delivery Reforms and Their Potential Impact on Diagnosis

8-1 Potential Areas of Research

9-1 Goals for Improving Diagnosis and Reducing Diagnostic Error

D-1 Examples of Diagnostic Error

Page xxiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

FIGURES

S-1 The diagnostic process

S-2 The work system in which the diagnostic process takes place

S-3 The outcomes from the diagnostic process

2-1 The committee’s conceptualization of the diagnostic process

2-2 The dual process model of diagnostic decision making

2-3 Calibration in the diagnostic process

2-4 Number of journal articles published on health care topics per year from 1970 to 2010

3-1 Outcomes from the diagnostic process

3-2 Places in the diagnostic process where failures can occur that contribute to diagnostic errors

4-1 Diagnostic team members and the tasks they perform are two elements of the work system in which the diagnostic process occurs

4-2 Teamwork in the diagnostic process includes the collaboration of a patient and his or her family members, diagnosticians, and health care professionals who support the diagnostic process

4-3 An example of diagnostic teamwork and the potential participants in the diagnostic process

5-1 Technologies and tools are an important element of the work system in which the diagnostic process occurs

6-1 Organizational characteristics and the physical environment are two elements of the work system in which the diagnostic process occurs

7-1 The diagnostic process is influenced by the external environment, including factors such as payment, reporting, medical liability, and oversight processes

7-2 Rates of use of medical imaging services and diagnostic testing compared with rates of other clinician-ordered services, per Medicare Beneficiary (2000–2007)

C-1 Venn diagram illustrating relationships between errors in the diagnostic process; missed, delayed, or wrong diagnoses; and adverse patient outcomes

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

Acronyms and Abbrevations

AAFP American Academy of Family Physicians
ABMS American Board of Medical Specialties
ACGME Accreditation Council for Graduate Medical Education
ACO accountable care organization
ACR American College of Radiology
AHRQ Agency for Healthcare Research and Quality
AMA American Medical Association
ANTS Anesthetists’ Non-Technical Skills
AOA American Osteopathic Association
APN advanced practice nurse
ASCP American Society for Clinical Pathology
CAD computer-aided detection
CAP College of American Pathologists
CBE competency-based evaluation
CCNE Commission on Collegiate Nursing Education
CDC Centers for Disease Control and Prevention
CDS clinical decision support
CEO chief executive officer
CLIA Clinical Laboratory Improvement Amendments
CLIAC Clinical Laboratory Improvement Advisory Committee
CMS Centers for Medicare & Medicaid Services
CPG clinical practice guideline
CPT current procedural terminology
CRP communication and resolution program
Page xxvi Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
CT computed tomography
DMT diagnostic management team
DOD Department of Defense
DRG diagnosis-related group
DSM Diagnostic and Statistical Manual of Mental Disorders
E&M evaluation and management
ED emergency department
EHR electronic health record
EKG electrocardiogram
FDA Food and Drug Administration
FFS fee-for-service
FMEA failure mode and effects analysis
GABHS Group A β-hemolytic streptococcus
GME graduate medical education
health IT health information technology
HFAP Healthcare Facilities Accreditation Program
HHS Department of Health and Human Services
HIMSS Healthcare Information Management Systems Society
HIV human immunodeficiency virus
HRO high reliability organization
ICD International Classification of Diseases
IOM Institute of Medicine
IPU integrated practice unit
IVD in vitro diagnostic test
LCME Liaison Committee on Medical Education
LDT laboratory developed test
LOINC Logical Observation Identifiers Names and Codes
M&M morbidity and mortality
MACRMI Massachusetts Alliance for Communication and Resolution following Medical Injury
MCAT Medical College Aptitude Test
mHealth mobile health
MI myocardial infarction
MIPPA Medicare Improvements for Patients and Providers Act
Page xxvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
MOC maintenance of certification
MQSA Mammography Quality Standards Act
MRI magnetic resonance imaging
NCQA National Committee for Quality Assurance
NDC National Drug Code
NIH National Institutes of Health
NLM National Library of Medicine
NLNAC National League for Nursing Accrediting Commission
NPDB National Practitioner Data Bank
NPSD Network of Patient Safety Databases
ONC Office of the National Coordinator for Health Information Technology
PA physician assistant
PCMH patient-centered medical home
PCORI Patient-Centered Outcomes Research Institute
PET positron emission tomography
PRI Physician Reciprocal Insurers
PSO patient safety organization
PSO PPC PSO Privacy Protection Center
PSQIA Patient Safety and Quality Improvement Act
PT proficiency testing
RSNA Radiological Society of North America
TeamSTEPPS Team Strategies and Tools to Enhance Performance and Patient Safety
UDP Undiagnosed Diseases Program
UMHS University of Michigan Health System
VA Department of Veterans Affairs
Page xxviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R1
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R2
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R3
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R4
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R5
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R6
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R8
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R10
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R11
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R13
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R14
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R15
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R16
Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R17
Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R18
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R19
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R20
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R21
Page xxii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R22
Page xxiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R23
Page xxiv Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R24
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R25
Page xxvi Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R26
Page xxvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R27
Page xxviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press. doi: 10.17226/21794.
×
Page R28
Next: Summary »
Improving Diagnosis in Health Care Get This Book
×
Buy Paperback | $69.95 Buy Ebook | $54.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

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.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!