Every nine minutes, someone in a U.S. hospital dies because a medical diagnosis was wrong or delayed.
To combat this issue, the AAFP has thrown its support behind ACT for Better Diagnosis,(betterdiagnosis.org) an initiative of the Society to Improve Diagnosis in Medicine (SIDM) that launched Sept. 13 and aims to improve the diagnostic process by calling on organizations to identify and spread practical steps to better ensure diagnoses are accurate, communicated and timely.
Specifically, the AAFP is supporting the initiative through its work with the Coalition to Improve Diagnosis,(www.improvediagnosis.org) a collaboration of more than 40 health care and patient advocacy organizations formed and led by the SIDM.
"Quality patient care is at the core of family medicine," AAFP President Michael Munger, M.D., of Overland Park, Kan., said of the Academy's work in this area. "Continuity of care, practicing evidence-based medicine and accurate diagnosis are tenets that family physicians are committed to and always improving upon. From the development of clinical practice guidelines and screening recommendations to reducing diagnostic errors, the AAFP will continue to champion accurate and timely diagnosis to improve quality patient care."
- As a member of the Coalition to Improve Diagnosis, the AAFP is supporting ACT for Better Diagnosis, an initiative of the Society to Improve Diagnosis in Medicine that aims to improve the diagnostic process by calling on organizations to identify and spread practical steps to better ensure diagnoses are accurate, communicated and timely.
- Coalition members collaborated to identify initial obstacles they think impede diagnostic accuracy.
- AAFP members are encouraged to share on social media what actions they are taking to improve diagnosis using the hashtag #betterdiagnosis.
Other coalition members include the American Academy of Pediatrics, American Cancer Society Action Network, American College of Physicians, American Heart Association, Institute for Healthcare Improvement, National Quality Forum and the Patient-Centered Primary Care Collaborative.
Federal liaisons participating in the coalition are the Agency for Healthcare Research and Quality (AHRQ), CDC, CMS and the Veterans Health Administration.
Each year, diagnostic errors affect 12 million adults in outpatient settings and are the most common cause of medical errors reported by patients, according to the SIDM.
"Providing an accurate medical diagnosis is complex and involves uncertainty, but it's obviously essential to effective and timely treatment," said Paul Epner, CEO and co-founder of the SIDM, in a Sept. 13 news release.(www.improvediagnosis.org) "Nearly everyone will receive an inaccurate diagnosis at some point in their life, and for some, the consequences will be grave. Major improvement is needed to systematically identify how to improve diagnostic quality and reduce harm to patients."
Members of the coalition are acting to improve the accuracy and timeliness of diagnoses through tactics such as providing online tools that help physicians recognize and avoid diagnostic pitfalls and improving medical education for new practitioners, as well as creating tools to support patients seeking a diagnosis. They will also develop tools that empower physicians, patients and caregivers to communicate test results in plain language.
Obstacles to Diagnostic Accuracy
Members of the Coalition to Improve Diagnosis have collaborated for months to identify initial obstacles they think impede diagnostic accuracy, such as:
- Incomplete communication during care transitions -- When patients are transferred between facilities, physicians or departments, there is potential for important information to slip through the cracks.
- Lack of measures and feedback -- Unlike many other patient safety issues, there are no standardized measures through which hospitals, health systems or physicians can understand their performance in the diagnostic process to guide improvement efforts or to report diagnostic errors. Providers rarely get feedback if a diagnosis was incorrect or changed.
- Limited support to help with clinical reasoning -- With hundreds of potential explanations for any one symptom, clinicians need timely, efficient access to tools and resources to assist in making diagnoses.
- Limited time -- Patients and their caregivers overwhelmingly report feeling rushed by limited appointment times, which poses real risks to gathering a complete history that is essential to formulating a working diagnosis; such time constraints also allow scant opportunity to thoroughly discuss any further steps in the diagnostic process and set appropriate expectations.
- The diagnostic process is complicated -- There is only limited information available to patients about which questions to ask, who to notify when changes in their condition occur or what constitutes serious symptoms. It's also unclear who is responsible for closing the loop on test results and referrals and how to communicate follow-up.
- Lack of funding for research -- The impact of inaccurate or delayed diagnoses on health care costs and patient harm has not been clearly articulated, and only a limited amount of published evidence exists to aid in identifying what improves the diagnostic process.
Related AAFP Efforts
For its part, the AAFP provides evidence-based guidance to facilitate accurate and timely diagnoses through the development of clinical practice guidelines, clinical preventive services recommendations and its Choosing Wisely campaign recommendations.
The Academy recently released five new Choosing Wisely recommendations aimed at reducing potentially unnecessary tests while providing patient-centered care through shared decision-making. That brings the AAFP's total number of Choosing Wisely recommendations(www.choosingwisely.org) to 20.
American Family Physician and familydoctor.org(familydoctor.org) also cover the AAFP's Choosing Wisely efforts and provide additional resources to facilitate discussions between family physicians and patients on appropriate tests and treatments.
According to the SIDM,(www.improvediagnosis.org) its efforts through the ACT for Better Diagnosis initiative have been bolstered by Congress, which it said noted in its Fiscal Year 2018 spending bill that improved diagnosis is a "moral, professional and public health imperative" and requested that "the AHRQ convene a cross-agency working group to propose a strategy to enhance scientific research to improve diagnosis in health care."
The bill also recommended including consideration of opportunities for public-private partnerships and the development of centers of excellence to propel research forward to improve diagnostic quality and safety.
ACT for Better Diagnosis is supported by the Gordon & Betty Moore Foundation and The Mont Fund.
AAFP members are encouraged to share on social media what actions they are taking to improve diagnosis using the hashtag #betterdiagnosis.
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