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Towards a National Diagnostic Excellence Dashboard - Partnering with Stakeholders to Construct Evidence-Based Operational Measures of Misdiagnosis-Related Harms

Award Number: R01HS027614
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Project Summary (Abstract) This four-year project combines the assets of a leading academic medical center (Johns Hopkins Medicine) with those of a recognized international leader in diagnostic excellence (Society to Improve Diagnosis in Medicine [SIDM]) and a major physician specialty society (American College of Emergency Physicians [ACEP]) to break new ground in operational measurement of patient harms linked to diagnostic error. To achieve the goal of improved patient outcomes through diagnostic excellence, it is essential to be able to measure diagnostic performance. Diagnostic errors are the largest cause of preventable harms in US medical care, affecting an estimated 12 million people each year, causing permanent disability or death in at least 0.5 million. Diagnostic safety is a priority research area for AHRQ and the National Academy of Medicine (NAM). A key impediment to “moving the needle” on reducing harms from diagnostic error is the lack of measures that matter to both patients and clinicians, yet can be fully operationalized (i.e., routinely monitored in the existing workflow). Impactful diagnostic outcome measures would assess serious morbidity and mortality in clinical contexts where diagnostic errors are known to occur. Ideal measures would be specific, valid, precise, and comparable across institutions to facilitate benchmarking that identifies both low and high outlier performers. This proposal uses a novel approach to constructing evidence-based diagnostic outcome measures with readily-available administrative and claims data sets. The Symptom-disease Pair Analysis of Diagnostic Error (“SPADE”) method first identifies a clinically-plausible relationship between a common presenting symptom and a dangerous underlying disease (e.g., chest pain-heart attack, fever-sepsis, dizziness-stroke). It then searches for a statistically-valid pattern of unexpected adverse events (e.g., observed greater than expected short-term inpatient hospitalization following a treat-and-release emergency department [ED] visit). Once such patterns are confirmed, they can be monitored to assess the impact of interventions to improve diagnosis. This proposal seeks to mature a partially-developed SPADE measure (for dizziness-stroke, a frequent cause of serious misdiagnosis-related harms) to the point of readiness for use in national benchmarking of hospital-level diagnostic performance for quality improvement. This SPADE pair has been validated through detailed chart review and statistical testing using data from four Johns Hopkins hospitals, and the National Quality Forum (NQF) has named this measure as a top priority for immediate development. This project will advance the measure towards broad adoption with two Specific Aims: (1) engage key national stakeholders to optimize attributes of the missed stroke measure (via expert panel and emergency physician survey) and (2) measure diagnostic performance of US hospital EDs using the refined missed stroke measure (via Medicare data analysis). These Aims will address stroke misdiagnosis now and, also, yield generalizable scientific insights. This will streamline future development of new measures of harm for other important symptom-disease pairs.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $398,466 )
2023	2023	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	5/12/2023	NON-COMPETING CONTINUATION	$398,466
														Subtotal = $398,466

Issue Date FY: 2022 ( Subtotal = $386,645 )
2022	2022	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	4/25/2022	NON-COMPETING CONTINUATION	$386,645
														Subtotal = $386,645

Issue Date FY: 2021 ( Subtotal = $372,122 )
2021	2021	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	4/8/2021	NON-COMPETING CONTINUATION	$372,122
														Subtotal = $372,122

Issue Date FY: 2020 ( Subtotal = $372,452 )
2020	2020	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	6/24/2020	NEW	$372,452
														Subtotal = $372,452

Grand Total All Awards = $1,529,685

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Towards a National Diagnostic Excellence Dashboard - Partnering with Stakeholders to Construct Evidence-Based Operational Measures of Misdiagnosis-Related Harms

Award Number: R01HS027614

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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