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:
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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