Department of Medical Education, University of Illinois, 808 S Wood St., Chicago, IL 60612, USA.
BMJ Qual Saf. 2012 Nov;21(11):918-24. doi: 10.1136/bmjqs-2012-000832. Epub 2012 Jul 7.
In a past study using unannounced standardised patients (USPs), substantial rates of diagnostic and treatment errors were documented among internists. Because the authors know the correct disposition of these encounters and obtained the physicians' notes, they can identify necessary treatment that was not provided and unnecessary treatment. They can also discern which errors can be identified exclusively from a review of the medical records.
To estimate the avoidable direct costs incurred by physicians making errors in our previous study.
In the study, USPs visited 111 internal medicine attending physicians. They presented variants of four previously validated cases that jointly manipulate the presence or absence of contextual and biomedical factors that could lead to errors in management if overlooked. For example, in a patient with worsening asthma symptoms, a complicating biomedical factor was the presence of reflux disease and a complicating contextual factor was inability to afford the currently prescribed inhaler. Costs of missed or unnecessary services were computed using Medicare cost-based reimbursement data.
Fourteen practice locations, including two academic clinics, two community-based primary care networks with multiple sites, a core safety net provider, and three Veteran Administration government facilities.
Contribution of errors to costs of care.
Overall, errors in care resulted in predicted costs of approximately $174,000 across 399 visits, of which only $8745 was discernible from a review of the medical records alone (without knowledge of the correct diagnoses). The median cost of error per visit with an incorrect care plan differed by case and by presentation variant within case.
Chart reviews alone underestimate costs of care because they typically reflect appropriate treatment decisions conditional on (potentially erroneous) diagnoses. Important information about patient context is often entirely missing from medical records. Experimental methods, including the use of USPs, reveal the substantial costs of these errors.
在过去的一项使用未宣布的标准化患者（USPs）的研究中，记录了内科医生大量的诊断和治疗错误。由于作者知道这些情况的正确处理方式，并获得了医生的记录，他们可以确定未提供和不必要的治疗。他们还可以辨别哪些错误仅从病历审查就可以识别。
估计我们之前的研究中医生犯错误所产生的可避免的直接成本。
在这项研究中，USPs 访问了 111 名内科主治医生。他们呈现了四个先前验证案例的变体，这些变体共同操纵了管理中可能因忽视而导致错误的上下文和生物医学因素的存在或不存在。例如，在一个哮喘症状恶化的患者中，一个复杂的生物医学因素是反流病的存在，一个复杂的上下文因素是无法负担当前开的吸入器。未提供或不必要的服务费用是使用医疗保险成本补偿数据计算的。
包括两个学术诊所、两个具有多个站点的社区初级保健网络、一个核心安全网提供商和三个退伍军人管理局政府设施在内的 14 个就诊地点。
错误对护理费用的贡献。
总体而言，护理中的错误导致 399 次就诊的预测费用约为 174000 美元，仅从病历审查（不了解正确诊断）就可发现其中的 8745 美元。每个错误护理计划的访问费用中位数因病例和病例内的呈现变体而异。
仅病历审查会低估护理费用，因为它们通常反映了在（潜在错误）诊断条件下的适当治疗决策。有关患者背景的重要信息通常完全缺失于病历中。实验方法，包括使用 USPs，可以揭示这些错误的巨大成本。
