Diagnostic Errors in Primary Care Pediatrics

Project RedDE

Michael L. Rinke, Hardeep Singh, Moonseong Heo, Jason S. Adelman, Heather C. O'Donnell, Steven J. Choi, Amanda Norton, Ruth E. K. Stein, Tammy M. Brady, Christoph U. Lehmann, Steven W. Kairys, Elizabeth Rice-Conboy, Keri Thiessen, David G. Bundy

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: Diagnostic errors (DEs), which encompass failures of accuracy, timeliness, or patient communication, cause appreciable morbidity but are understudied in pediatrics. Pediatricians have expressed interest in reducing high-frequency/subacute DEs, but their epidemiology remains unknown. The objective of this study was to investigate the frequency of two high-frequency/subacute DEs and one missed opportunity for diagnosis (MOD) in primary care pediatrics. Methods: As part of a national quality improvement collaborative, 25 primary care pediatric practices were randomized to collect 5 months of retrospective data on one DE or MOD: elevated blood pressure (BP) and abnormal laboratory values (DEs), or adolescent depression evaluation (MOD). Relationships between DE or MOD proportions and patient age, gender, and insurance status were explored with mixed-effects logistic regression models. Results: DE or MOD rates in pediatric primary care were found to be 54% for patients with elevated BP (n = 389), 11% for patients with abnormal laboratory values (n = 381), and 62% for adolescents with an opportunity to evaluate for depression (n = 400). When examining the number of times a pediatrician may have recognized an abnormal condition but either knowingly or unknowingly did not act according to recommended guidelines, providers did not document recognition of an elevated BP in 51% of patients with elevated BP, and they did not document recognition of an abnormal laboratory value without a delay in 9% of patients with abnormal laboratory values. Conclusions: DEs and MODs occur at an appreciable frequency in pediatric primary care. These errors may contribute to care delays and patient harm.

Original languageEnglish (US)
JournalAcademic Pediatrics
DOIs
StateAccepted/In press - 2017

Fingerprint

Diagnostic Errors
Primary Health Care
Pediatrics
Blood Pressure
Logistic Models
Depression
Patient Harm
Insurance Coverage
Quality Improvement
Epidemiology
Communication
Guidelines
Morbidity

Keywords

  • Depression
  • Diagnostic errors
  • Hypertension
  • Laboratory
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Diagnostic Errors in Primary Care Pediatrics : Project RedDE. / Rinke, Michael L.; Singh, Hardeep; Heo, Moonseong; Adelman, Jason S.; O'Donnell, Heather C.; Choi, Steven J.; Norton, Amanda; Stein, Ruth E. K.; Brady, Tammy M.; Lehmann, Christoph U.; Kairys, Steven W.; Rice-Conboy, Elizabeth; Thiessen, Keri; Bundy, David G.

In: Academic Pediatrics, 2017.

Research output: Contribution to journalArticle

Rinke, ML, Singh, H, Heo, M, Adelman, JS, O'Donnell, HC, Choi, SJ, Norton, A, Stein, REK, Brady, TM, Lehmann, CU, Kairys, SW, Rice-Conboy, E, Thiessen, K & Bundy, DG 2017, 'Diagnostic Errors in Primary Care Pediatrics: Project RedDE', Academic Pediatrics. https://doi.org/10.1016/j.acap.2017.08.005
Rinke, Michael L. ; Singh, Hardeep ; Heo, Moonseong ; Adelman, Jason S. ; O'Donnell, Heather C. ; Choi, Steven J. ; Norton, Amanda ; Stein, Ruth E. K. ; Brady, Tammy M. ; Lehmann, Christoph U. ; Kairys, Steven W. ; Rice-Conboy, Elizabeth ; Thiessen, Keri ; Bundy, David G. / Diagnostic Errors in Primary Care Pediatrics : Project RedDE. In: Academic Pediatrics. 2017.
@article{ba60dc01cdaa4b7392f38776a45f3c70,
title = "Diagnostic Errors in Primary Care Pediatrics: Project RedDE",
abstract = "Objective: Diagnostic errors (DEs), which encompass failures of accuracy, timeliness, or patient communication, cause appreciable morbidity but are understudied in pediatrics. Pediatricians have expressed interest in reducing high-frequency/subacute DEs, but their epidemiology remains unknown. The objective of this study was to investigate the frequency of two high-frequency/subacute DEs and one missed opportunity for diagnosis (MOD) in primary care pediatrics. Methods: As part of a national quality improvement collaborative, 25 primary care pediatric practices were randomized to collect 5 months of retrospective data on one DE or MOD: elevated blood pressure (BP) and abnormal laboratory values (DEs), or adolescent depression evaluation (MOD). Relationships between DE or MOD proportions and patient age, gender, and insurance status were explored with mixed-effects logistic regression models. Results: DE or MOD rates in pediatric primary care were found to be 54{\%} for patients with elevated BP (n = 389), 11{\%} for patients with abnormal laboratory values (n = 381), and 62{\%} for adolescents with an opportunity to evaluate for depression (n = 400). When examining the number of times a pediatrician may have recognized an abnormal condition but either knowingly or unknowingly did not act according to recommended guidelines, providers did not document recognition of an elevated BP in 51{\%} of patients with elevated BP, and they did not document recognition of an abnormal laboratory value without a delay in 9{\%} of patients with abnormal laboratory values. Conclusions: DEs and MODs occur at an appreciable frequency in pediatric primary care. These errors may contribute to care delays and patient harm.",
keywords = "Depression, Diagnostic errors, Hypertension, Laboratory, Pediatrics",
author = "Rinke, {Michael L.} and Hardeep Singh and Moonseong Heo and Adelman, {Jason S.} and O'Donnell, {Heather C.} and Choi, {Steven J.} and Amanda Norton and Stein, {Ruth E. K.} and Brady, {Tammy M.} and Lehmann, {Christoph U.} and Kairys, {Steven W.} and Elizabeth Rice-Conboy and Keri Thiessen and Bundy, {David G.}",
year = "2017",
doi = "10.1016/j.acap.2017.08.005",
language = "English (US)",
journal = "Academic Pediatrics",
issn = "1876-2859",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Diagnostic Errors in Primary Care Pediatrics

T2 - Project RedDE

AU - Rinke, Michael L.

AU - Singh, Hardeep

AU - Heo, Moonseong

AU - Adelman, Jason S.

AU - O'Donnell, Heather C.

AU - Choi, Steven J.

AU - Norton, Amanda

AU - Stein, Ruth E. K.

AU - Brady, Tammy M.

AU - Lehmann, Christoph U.

AU - Kairys, Steven W.

AU - Rice-Conboy, Elizabeth

AU - Thiessen, Keri

AU - Bundy, David G.

PY - 2017

Y1 - 2017

N2 - Objective: Diagnostic errors (DEs), which encompass failures of accuracy, timeliness, or patient communication, cause appreciable morbidity but are understudied in pediatrics. Pediatricians have expressed interest in reducing high-frequency/subacute DEs, but their epidemiology remains unknown. The objective of this study was to investigate the frequency of two high-frequency/subacute DEs and one missed opportunity for diagnosis (MOD) in primary care pediatrics. Methods: As part of a national quality improvement collaborative, 25 primary care pediatric practices were randomized to collect 5 months of retrospective data on one DE or MOD: elevated blood pressure (BP) and abnormal laboratory values (DEs), or adolescent depression evaluation (MOD). Relationships between DE or MOD proportions and patient age, gender, and insurance status were explored with mixed-effects logistic regression models. Results: DE or MOD rates in pediatric primary care were found to be 54% for patients with elevated BP (n = 389), 11% for patients with abnormal laboratory values (n = 381), and 62% for adolescents with an opportunity to evaluate for depression (n = 400). When examining the number of times a pediatrician may have recognized an abnormal condition but either knowingly or unknowingly did not act according to recommended guidelines, providers did not document recognition of an elevated BP in 51% of patients with elevated BP, and they did not document recognition of an abnormal laboratory value without a delay in 9% of patients with abnormal laboratory values. Conclusions: DEs and MODs occur at an appreciable frequency in pediatric primary care. These errors may contribute to care delays and patient harm.

AB - Objective: Diagnostic errors (DEs), which encompass failures of accuracy, timeliness, or patient communication, cause appreciable morbidity but are understudied in pediatrics. Pediatricians have expressed interest in reducing high-frequency/subacute DEs, but their epidemiology remains unknown. The objective of this study was to investigate the frequency of two high-frequency/subacute DEs and one missed opportunity for diagnosis (MOD) in primary care pediatrics. Methods: As part of a national quality improvement collaborative, 25 primary care pediatric practices were randomized to collect 5 months of retrospective data on one DE or MOD: elevated blood pressure (BP) and abnormal laboratory values (DEs), or adolescent depression evaluation (MOD). Relationships between DE or MOD proportions and patient age, gender, and insurance status were explored with mixed-effects logistic regression models. Results: DE or MOD rates in pediatric primary care were found to be 54% for patients with elevated BP (n = 389), 11% for patients with abnormal laboratory values (n = 381), and 62% for adolescents with an opportunity to evaluate for depression (n = 400). When examining the number of times a pediatrician may have recognized an abnormal condition but either knowingly or unknowingly did not act according to recommended guidelines, providers did not document recognition of an elevated BP in 51% of patients with elevated BP, and they did not document recognition of an abnormal laboratory value without a delay in 9% of patients with abnormal laboratory values. Conclusions: DEs and MODs occur at an appreciable frequency in pediatric primary care. These errors may contribute to care delays and patient harm.

KW - Depression

KW - Diagnostic errors

KW - Hypertension

KW - Laboratory

KW - Pediatrics

UR - http://www.scopus.com/inward/record.url?scp=85030759175&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030759175&partnerID=8YFLogxK

U2 - 10.1016/j.acap.2017.08.005

DO - 10.1016/j.acap.2017.08.005

M3 - Article

JO - Academic Pediatrics

JF - Academic Pediatrics

SN - 1876-2859

ER -