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:

How gene mutation causes autism and intellectual disability
Scientists have discovered why a specific genetic mutation causes intellectual disability and autism spectrum disorder in children.
Is disability a risk factor for miscarriage?
A new study compared the proportion of women with any cognitive, physical, or independent living disability who experienced a miscarriage during the previous 5-year period to women without disabilities.
'Climate change is a disability rights issue'
In a high-profile Letter in Science, University of Konstanz climate scientist and ecologist Dr Aleksandra Kosanic, an Associate Fellow of the University of Konstanz's Zukunftskolleg, draws attention to the fact that disabled populations have, until now, been absent from international conversations about climate change and its impact.
Predicting frailty, disability and death
In a study led by investigators from Brigham and Women's Hospital, researchers analyzed patterns of movement among elderly study participants and found that irregular, spontaneous fluctuations could predict a person's risk of frailty, disability and death years later.
Movement patterns predict frailty and disability in the elderly
Elderly people who show more random changes in daily movement tend to be at greater risk of frailty, disability and death, according to a large study involving 1,275 individuals over the course of 13 years.
IQSEC1 gene mutations cause new intellectual disability syndrome
Researchers identify gene causing intellectual disability syndrome that is common in countries where consanguineous marriages are prevalent.
Best medications to reduce drooling for those with developmental disability
A new study has revealed the most effective medications to reduce drooling in young people with a developmental disability, which can affect their socialisation, relationships and community life.
Obesity worsens disability in multiple sclerosis
Obesity is an aggravating factor in relapsing-remitting multiple sclerosis, the most common form of the disease.
Musculoskeletal conditions now second global cause of years lived with disability
Musculoskeletal (MSK) conditions, which affect the body's joints, bones, muscles, tendons and ligaments, now rank as the second leading global cause of years lived with a disability, reveals an analysis of international data, published online in the Annals of the Rheumatic Diseases.
Rehabilitation psychologists: #SayTheWord disability
A group of female rehabilitation psychologists with disabilities highlight the need for clinicians, educators and disability allies to normalize the word 'disability.'
More Disability News and Disability Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Clint Smith
The killing of George Floyd by a police officer has sparked massive protests nationwide. This hour, writer and scholar Clint Smith reflects on this moment, through conversation, letters, and poetry.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Graham
If former Minneapolis police officer Derek Chauvin's case for the death of George Floyd goes to trial, there will be this one, controversial legal principle looming over the proceedings: The reasonable officer. In this episode, we explore the origin of the reasonable officer standard, with the case that sent two Charlotte lawyers on a quest for true objectivity, and changed the face of policing in the US. This episode was produced by Matt Kielty with help from Kelly Prime and Annie McEwen. Support Radiolab today at Radiolab.org/donate.