Nav: Home

A method to measure diagnostic errors could be key to preventing disability and death from misdiagnosis

January 22, 2018

In an effort to reduce patient misdiagnoses and associated poor patient outcomes from lack of prompt treatment, a Johns Hopkins Armstrong Institute for Patient Safety and Quality researcher is helping to lead the way in providing hospitals a new approach to quantify and monitor diagnostic errors in their quality improvement efforts. The approach, called Symptom-Disease Pair Analysis of Diagnostic Error, or SPADE, is featured in a paper published today in BMJ Quality & Safety.

Various research studies reveal that an estimated 12 million Americans are affected each year by diagnostic errors, with one in three errors leading to serious patient injuries, including disability or death.

"We know diagnostic errors are a big problem, but we currently have no way of operationally measuring them," says David Newman-Toker, M.D., Ph.D., director of the Armstrong Institute Center for Diagnostic Excellence. While some research was previously done by his and other groups on a smaller scale, "This is the first real description of a method that could be used broadly across a range of conditions to operationally measure diagnostic errors and associated bad outcomes so that we can track our performance and see whether our interventions are making a difference," Newman-Toker says.

Many current methods of measuring diagnostic errors rely on labor-intensive medical record reviews by hospital staff members. The SPADE method mines large, readily available databases with hundreds of thousands of patient visits, using specific algorithms to look for common symptoms prompting a doctor visit and then pairing them with one or more diseases that could be misdiagnosed in those clinical contexts. The method uses statistical analyses to identify critical patterns that measure the rate of diagnostic error and could be incorporated into diagnostic performance dashboards. "Using SPADE, we can measure how often a patient comes to the hospital with dizziness, is mistakenly told it's a benign ear condition, is sent home, and comes back with a big stroke. We can also measure how often a patient comes to a clinic with a fever, is told it's a viral infection, but is later admitted to the hospital with bacterial sepsis," says Newman-Toker, who is also a professor of neurology at the Johns Hopkins University School of Medicine. "And being able to do that using big data is an important innovation for diagnostic quality and safety."

Newman-Toker also believes SPADE, in turn, will lead to improved patient outcomes. "Many quality measures focus on hospital processes, rather than patient outcomes. But it's not about treating the charts, it's about treating the patients. At Johns Hopkins, we focus on tracking serious adverse outcomes, such as stroke or heart attack. These measures will matter to patients," he says.

SPADE will work best with acute and subacute diseases for which a misdiagnosis that leads to hospitalization, disability or death is likely to occur within six months to a year. Further research is needed to validate SPADE across a wider range of symptoms and diseases. The method may not ultimately be applicable to all diseases, especially chronic conditions, but Newman-Toker expects it will work for what he calls "The Big Three" causes of disability and death from diagnostic error: vascular events, infections and cancers.

Thinking toward the future, Newman-Toker understands that physician and hospital leadership "buy-in" relating to tracking diagnostic errors may take time. However, he believes SPADE could eventually be among hospitals' publicly reported measures. "Patients will have the opportunity, for the first time, to see how their hospital is performing on diagnosis and ask themselves, 'Do I want to choose a hospital that has fewer misdiagnosis-related deaths?'" Newman-Toker says. "And that is a step towards patient empowerment in diagnosis that has never existed before."
-end-
Other researchers involved in this study include Ava Liberman, M.D., vascular neurologist, The Stern Stroke Center, Montefiore Health System and assistant professor of neurology, The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine.

Funding for this study was provided by the National Institute on Deafness and Other Communication Disorders (U01 DC013778) and the Armstrong Institute Center for Diagnostic Excellence.

Johns Hopkins Medicine

Related Disability Articles:

Loss of spinal nerve fibers not the only cause of disability in multiple sclerosis
Researchers from Queen Mary University of London have now sampled spinal cords of thirteen people with MS and five healthy controls, and found that spinal cord cross sectional area is not a good predictor of axonal loss.
Scientists unravel how protein impacts intellectual disability
Scientists from the Florida campus of The Scripps Research Institute (TSRI) have shown that a protein helps balance nerve cell communication.
Study links 26 novel genes to intellectual disability
Researchers at Canada's Centre for Addiction and Mental Health (CAMH) and Queen's University have identified 26 new genes linked to intellectual disability.
Regular exercise, not BMI, before stroke may predict disability later
A new study suggests it's the amount of regular exercise people get, not the amount of body fat they have, that may predict just how well they recover from a stroke.
OTUD6B gene mutations cause intellectual and physical disability
An international team of researchers from institutions around the world, including Baylor College of Medicine, has discovered that mutations of the OTUD6B gene result in a spectrum of physical and intellectual deficits.
Prevalence of disability among students in US medical schools
New research has identified a higher prevalence of disability among students in US allopathic medical schools (2.7 percent) than prior studies (0.3 percent to 0.6 percent), according to a study appearing in the Dec.
MS drug may reverse some physical disability
A drug used to treat multiple sclerosis, alemtuzumab, was found to reverse some of the physical disability caused by the disease, according to new research published in the Oct.
Cerebral microbleeds in MS are associated with increased risk for disability
Leaky blood vessels in the brain called cerebral microbleeds are associated with an increased risk of physical and cognitive disability in patients with multiple sclerosis (MS), according to a new study by researchers in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.
Longer life, disability free
Harvard researchers are among the co-authors of a new study that shows that the increase in life expectancy in the past two decades has been accompanied by an even greater increase in life years free of disability, thanks in large measure to improvements in cardiovascular health and declines in vision problems.
Discover the genetic cause for intellectual disability
A research group led by Osaka University and collaborative institutions discovered that disorders in the same gene PIGG are the cause for intellectual disability with seizures and hypotonia.

Related Disability Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Bias And Perception
How does bias distort our thinking, our listening, our beliefs... and even our search results? How can we fight it? This hour, TED speakers explore ideas about the unconscious biases that shape us. Guests include writer and broadcaster Yassmin Abdel-Magied, climatologist J. Marshall Shepherd, journalist Andreas Ekström, and experimental psychologist Tony Salvador.
Now Playing: Science for the People

#514 Arctic Energy (Rebroadcast)
This week we're looking at how alternative energy works in the arctic. We speak to Louie Azzolini and Linda Todd from the Arctic Energy Alliance, a non-profit helping communities reduce their energy usage and transition to more affordable and sustainable forms of energy. And the lessons they're learning along the way can help those of us further south.