From the MedStar Health Research Institute, Washington, District of Columbia.
Department of Family Medicine, Georgetown University School of Medicine, Washington, District of Columbia.
J Patient Saf. 2024 Dec 1;20(8):556-563. doi: 10.1097/PTS.0000000000001283. Epub 2024 Sep 17.
One in 20 outpatients in the United States experiences a diagnostic error each year, but there are no validated methods for collecting feedback from patients on diagnostic safety. We examined patient experience surveys to determine whether patients' free text comments indicated diagnostic breakdowns. Our objective was to evaluate associations between patient-perceived diagnostic breakdowns reported in free text comments and patients' responses to structured survey questions.
We conducted an exploratory mixed methods study using data from patient experience surveys collected from adult ambulatory care patients March 2020 to June 2020 in a large U.S. health system. Data analysis included content analysis of qualitative data and statistical analysis of quantitative data.
In 2525 surveys with negative comments, 619 patients (24.5%) identified diagnostic breakdowns, including issues with accuracy (n = 282, 46%), timeliness (n = 243, 39%), or communication (n = 290, 47%); some patients (n = 181) reported breakdowns in multiple categories. Patients who gave a low average score (50 or less on a 100-point scale) on provider questions were almost seven times more likely to perceive a diagnostic breakdown than patients who scored their provider higher. Similarly, patients who gave a low average score on practice-related questions were twice as likely to perceive a diagnostic breakdown.
Patient feedback in routinely collected patient experience surveys is a valuable and actionable information source on diagnostic breakdowns in the ambulatory setting. The more easily monitored structured survey data provide a screening method to identify encounters that may have included a patient-perceived diagnostic breakdown and therefore require further examination.
每年，美国有五分之一的门诊患者会经历诊断错误，但目前尚无有效的方法从患者处收集有关诊断安全性的反馈。我们对患者体验调查进行了研究，以确定患者的自由文本评论是否表明存在诊断错误。我们的目的是评估患者在自由文本评论中报告的感知诊断错误与患者对结构化调查问题的反应之间的关联。
我们开展了一项探索性混合方法研究，使用了 2020 年 3 月至 6 月期间在美国某大型医疗系统的成年门诊患者中收集的患者体验调查数据。数据分析包括对定性数据的内容分析和对定量数据的统计分析。
在 2525 份带有负面评价的调查中，有 619 名患者（24.5%）发现了诊断错误，包括准确性问题（n=282，46%）、及时性问题（n=243，39%）或沟通问题（n=290，47%）；一些患者（n=181）报告了多个类别的错误。在医生相关问题上评分较低（100 分制中得分 50 或以下）的患者感知到诊断错误的可能性几乎是评分较高的患者的七倍。同样，在与实践相关的问题上评分较低的患者感知到诊断错误的可能性是评分较高的患者的两倍。
从常规收集的患者体验调查中获取的患者反馈是一种有价值且可采取行动的信息来源，可了解门诊环境中的诊断错误。更容易监测的结构化调查数据提供了一种筛选方法，可识别可能包含患者感知到的诊断错误的就诊情况，因此需要进一步检查。
