End Diagnostic Overshadowing: Understanding and Reducing Diagnostic Error in Patients With Disabilities
Rush University Medical Center
Summary
The goal of this study is to address the critical issue of diagnostic overshadowing by applying the Collective Impact Model40 to co-produce our End Diagnostic Overshadowing program with academic, health systems, health professional, PWDs, family members, and community stakeholders. Through this work, we will identify and address mechanisms that contribute to diagnostic overshadowing and diagnostic errors among people with disabilities. The main questions to answer are whether knowledge about diagnostic errors and confidence will improve with health care providers and professionals involved in diagnostic provesses, whether developed algorithms to identify patients at risk of diagnpstic error will be used, whether there will be change in time to diagnostic evaluation for PWD from the specified 5 population groups and with the specified diagnoses prone to error, and whether changes in usage of CPT Evaluation and Management codes will occur.
Description
People with disabilities (PWD) experience increased risk of diagnostic error-sometimes due to attributing symptoms to disability rather than a potentially new or co-morbid conditions. As well, some diagnoses are prone to error. Based on literature we identified the following twenty-six diagnoses prone to error with ICD-10 codes: Aortic aneurysm and dissection I71.0 - I71.9; Arterial thromboembolism I74.0 - I74.9; Venous thromboembolism I82.0-I82.99 and I82.A-I82.C; Congestive heart failure I50.1-150.9; Stroke All I60, I61, I62, I63, I64; Myocardial infarction I21.0-I21.9 and I21.A-I21.B; Spina…
Eligibility
- Age range
- 3–89 years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: • Patients aged 3-89 who received billed charges Exclusion Criteria: * Patients under age 3 or over age 89. * Patients with secondary diagnosis of dementia as the population is already known to be at increased risk of diagnostic error
Interventions
- BehavioralElectonic health record prompts with education
1. . A baseline description of patients aged ≥ 3 to 89 years old with one or more of 26 diagnoses prone to error was developed to compare cases of patients with specific disabilities (major mobility impairments, severe mental health concerns, severe visual impairments, severe hearing loss, and IDD) versus cases of patients without the specific disabilities who have these diagnoses. 2. Initial manual chart reviews on PWDs with specific diagnoses of sepsis and metastatic breast cancer with two of the disability groups, patients with intellectual disabilities and/or autism and with severe mental illness were done. 3. We analyzed mammogram usage and factors related to usage among women ≥ 40 years old with IDD and with severe mental health issues 3\) We are working on algorithms to identify providers whose female patients age \> 40 years old to encourage outreach and to identify the patients needing mammograms for outreach. Developing educational materials for both providers and patients.
- OtherStandard of care
Patients without disabilities will receive standard care related to electronic health record prompts, alerts, and decision supports.
Location
- Rush University Medical CenterChicago, Illinois