Identifying psychiatric diagnostic errors with the Safer Dx Instrument.

Fletcher, Terri L; Helm, Ashley; Vaghani, Viralkumar; Kunik, Mark E; Stanley, Melinda A; Singh, Hardeep

Fletcher, Terri L; Helm, Ashley; Vaghani, Viralkumar; Kunik, Mark E; Stanley, Melinda A; Singh, Hardeep.

Afiliación

Fletcher TL; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA.
Helm A; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Vaghani V; VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX 77030, USA.
Kunik ME; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Stanley MA; VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX 77030, USA.
Singh H; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA.

Int J Qual Health Care ; 32(6): 405-411, 2020 Jul 20.

Article en En | MEDLINE | ID: mdl-32671387

RESUMEN

OBJECTIVE: Diagnostic errors in psychiatry are understudied partly because they are difficult to measure. The current study aimed to adapt and test the Safer Dx Instrument, a structured tool to review electronic health records (EHR) for errors in medical diagnoses, to evaluate errors in anxiety diagnoses to improve measurement of psychiatric diagnostic errors. DESIGN: The iterative adaptation process included a review of the revised Safer Dx-Mental Health Instrument by mental health providers to ensure content and face validity and review by a psychometrician to ensure methodologic validity and pilot testing of the revised instrument. SETTINGS: None. PARTICIPANTS: Pilot testing was conducted on 128 records of patients diagnosed with anxiety in integrated primary care mental health clinics. Cases with anxiety diagnoses documented in progress notes but not included as a diagnosis for the encounter (n = 25) were excluded. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): None. RESULTS: Of 103 records meeting the inclusion criteria, 62 likely involved a diagnostic error (42 from use of unspecified anxiety diagnosis when a specific anxiety diagnosis was warranted; 20 from use of unspecified anxiety diagnosis when anxiety symptoms were either undocumented or documented but not severe enough to warrant diagnosis). Reviewer agreement on presence/absence of errors was 88% (κ = 0.71). CONCLUSION: The revised Safer Dx-Mental Health Instrument has a high reliability for detecting anxiety-related diagnostic errors and deserves testing in additional psychiatric populations and clinical settings.

Asunto(s)

Ansiedad/diagnóstico; Errores Diagnósticos; Registros Electrónicos de Salud; Adulto; Prestación Integrada de Atención de Salud; Femenino; Hospitales de Veteranos; Humanos; Masculino; Persona de Mediana Edad; Proyectos Piloto; Atención Primaria de Salud; Reproducibilidad de los Resultados; Estados Unidos; United States Department of Veterans Affairs

Palabras clave

anxiety; diagnostic error; psychiatric diagnosis

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ansiedad / Errores Diagnósticos / Registros Electrónicos de Salud Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Int J Qual Health Care Asunto de la revista: SERVICOS DE SAUDE Año: 2020 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido

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