Improving Diagnostic Equity in Ambulatory care Settings (I.D.E.A.S.): Research to Practice - PROJECT SUMMARY
The diagnostic process is an iterative, time-dependent, and collaborative decision-making process under
uncertainty to reach an explanation for the patient’s health condition(s) and communicate this explanation to
the patient. Appropriate healthcare delivery depends on the proximity between a patient’s health condition and
diagnosis and yet, diagnostic errors remain a leading cause of morbidity and mortality in the U.S. Considering
the volume and variety of primary care patients, combined with the practical challenges of scarce and costly
referral and testing resources, the incidence of diagnostic errors can disproportionally affect medically
underserved and vulnerable patient populations. Diagnostic disparities occur when preventable diagnostic errors
are experienced disproportionately among certain patient demographic subgroups. Research has shown
disparities in diagnostic error
s
by race and ethnicity, sex, gender, geographic location, and socioeconomic status,
in part due to implicit bias, discrimination, and stigma. However, the relationship between diagnostic equity
(i.e., diagnostic disparities related to diagnostic error due to systemic challenges in policies and practices) and
diagnostic uncertainty (i.e., subjective perception of an inability to provide an accurate explanation of the
patient's health problem) is poorly understood. Diagnostic uncertainty, a concept that has yet to be adequately
operationalized in medical practice, is a natural part of medicine and more common in primary care than any
other specialty. Identification of indicators and causes for diagnostic errors is crucial to avoid patient harm.
Previous studies linked diagnostic uncertainty to diagnostic variation (i.e., physicians providing different
diagnosis for the same patient), over-testing, increased hospitalization, and referrals. Yet, the connection
between diagnostic uncertainty and diagnostic equity remains an understudied domain.
While there is an increasing need to develop data-driven and evidence-based methods to study the relationship
between diagnostic equity and diagnostic uncertainty, the complexity, time dependency, and uncertainty of
the diagnostic process makes this challenging. Therefore, we have developed the Improving Diagnostic Equity
in Ambulatory care Settings (I.D.E.A.S.): Research to Practice study to evaluate diagnostic errors in the context
of diagnostic equity and diagnostic uncertainty through the application of decision-modeling and human factors
methodologies. The novelty of the proposed study lies in its unique interdisciplinary approach, bringing together
clinical diagnostician expertise, data science, operations research, and human factors engineering, to work
towards methodological advances in conceptualizing and measuring diagnostic errors. Expected outcomes will
lay the foundation for designing a comprehensive framework via an equity lens to connect diagnostic equity and
diagnostic uncertainty to inform interventions aimed at reducing diagnostic inequity and improving the
management of diagnostic uncertainty.
