• Despite tremendous advances to make healthcare safer, patient safety still poses a major quality challenge. One important aspect of safety that needs improvement is the quality of diagnoses. Each year in the United States, at least 5 percent of adults seeking care in outpatient settings, such as a doctor’s office, experience an inaccurate or delayed diagnosis. These errors cause many patients harm and contribute to nearly 10 percent of patient deaths annually. NQF has issued new measurement guidance to help improve the quality and safety of diagnoses.

    “Most people will experience at least one diagnostic error in their lifetime,” said Shantanu Agrawal, MD, MPhil. “NQF’s guidance will be key to changing this unacceptable paradigm and make these critical junctures in care more accurate, and safer, for all Americans.”

    Building on the seminal 2015 Institute of Medicine report, Improving Diagnosis in Health Care, NQF in 2016 convened a multistakeholder committee to develop a structure for measuring diagnostic quality and safety and identify priorities for future measure development. In a final report issued in September 2017, NQF recommends measuring 11 aspects of diagnostic safety and quality in three broad categories:

    • experiences and engagement of patients, their families, and caregivers
    • the diagnostic process itself, which could include how information is gathered and shared, as well as how efficient and accurate it is
    • organizational and policy opportunities, which include looking at efforts to learn from diagnostic errors as well as the availability of appropriate staff and services

    The measurement structure is intended to facilitate systematic identification and prioritization of measure gaps—areas where there are not enough measures to help improve care—and to help guide efforts to fill those gaps through measure development and endorsement.

    The committee identified high-priority areas where measures are needed, including timeliness of diagnosis, timeliness of test result follow-up, patient experience of diagnostic care, and communication between providers as well as providers and patients during transitions of care.

    Improving diagnostic safety and quality goes beyond measures, however, and NQF shared cross-cutting guidance from the committee on issues that affect the ability to make improvements. For example, diagnostic accuracy can advance significantly if electronic health records (EHRs) support collection of key diagnostic data and are interoperable within and across healthcare systems. The committee also suggested engaging with medical specialty societies for input on measures for conditions that are frequently misdiagnosed. In addition, the committee recommended that diagnostic safety and quality become an important component of professional education.

    “Although diagnosis can be complex, especially for patients with serious conditions, it’s imperative that the healthcare system do all that it can to get it right. NQF’s work is a foundational component of important efforts to make diagnosis more accurate, reliable, and safe,” said Mark L. Graber, MD, president and founder of the Society to Improve Diagnosis in Medicine, and senior fellow at the research institute, RTI International. Graber co-chaired NQF’s Diagnostic Quality and Safety Committee with Missy Danforth, vice president, hospital ratings, at The Leapfrog Group.

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